Tf-tS DAWNfNC. OF A NSW DAY
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Illness Management i
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Self-Directed Recovery
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Table of Contents ,
Talking Story Part 1 - Let's Get to Know Each Other.....,,....,,..,.,,,............,.....,,..,. 1
B Talking Story Part 2 - Kumu Ola Pono - The Wai' anae Wellness Model.......................2 D
I a: ng ::ory :ar:!- denti yin;hstcengthstan; Weaknesses..............................!....... I
Fe oya e oB.ec ve6-.....d.. .................................
acts a out 1po ar 1sor er.............................5...
Pathway 2 - Learning the Practical Facts about Schizophrenia 6
Pathway 3 - Learning the Practical Facts about Depression ?
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;, Pathway 4 - A Look at the Stress-Vulnerability Model.......................................................8 ;x,
Pathway 5 - Building Circles of Friends 9
Pathway 6 - Using Medication Effectively................................................................1 0
Pathway 7- The Effects of Drug and Alcohol Use...........................................................1 1.
Pathway 8 - Solving Pilikia and Achieving Goals....................................................................1 2.
Pathway 9 - Building Strengths and Reducing Crises..........................................................1..3.. Pathway 10 - Getting Your Needs Met in the Mental Health System 14
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achment s..............................................................................................................................................15 P.i--'t'.'
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DIE AND OLA ;'
Stigma
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5• Four Agreements !, :,
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tl--';'.<il 10. Article: Contextualizing the symptom in multicultural consultation: Anger in a tl--'{<il tl-•\<il cultural-historical context tl-•\<ll
iX@ 11. Exploring the Ho' oponopono Process
!, :, Notes............................................................................................................................................................ 16 :,
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Addendum.............................................................................................................................................17 f{
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HaleNa'auPono
Wai'anae Coast Community Mental Health Center, Inc. 86-226 Farrington Highway Wai'anae, Hawaii 96792
Telephone: (808) 696-4211 Fax: (808) 696-5516
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Talking Story - (Part 1) D
Let's Get to Know Each
Other a
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Mq ''We l1°na00
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(A Wel'coming Call)
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Guiding Principles at Hale Na'au Pono :
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life health well-oe1na. save heal thrive :
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I;i Human societies operate on underlying beliefs, sometimes referred to as "Deep
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have a number of such cultures. In Hawai' i, we have two distinct deep cultures, one 1 based on domination, individualism, and exclusion, for which we use three reminder
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alphabets, D.I.E, and another based on 'oluolu (non-confrontational and pleasing), P.}-' lokahi (unity) & aloha (compassion, kindness, loving) for which we use O.L.A. We have chosen to be guided by the second, more caring, softer, sustaining and healthier culture. (See Attachment! on DIE and OLA)
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direction.)
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'Olelo No' eau, Hawaiian Proverbs and Poetical Sayings,
Mary Kawena Puku' i, Bishop Museum Press (1983) #1102
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A Walk Around the Block
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Popo would push the baby cart around the two-mile block in Lualualei valley from Pu'uhulu Road, up Kuwale, down Lualualei, and across
Puhawai, to show her grand baby Pohaokalani the sights, smells and
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sounds of the country-side. Whenever she came to the pasture, she'd do l
the grandmother ""googoo---gahgah" routine, trying to build interest and
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excitement in her 1 year old grandson as they went past the horses and cows grazing. But all Poha would do was look disinterested and drool.
On the third day around the block, Popo needed more gratification
than she was getting for pushing the baby carriage two miles around.
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animals, she got the same non-response. I
Ij When she got to the pasture and stopped for the baby to see the So, Popo got her 70 year-old body down low, placing her eye level at
the level of Poha's, and there she saw what baby was seeing. All Poha
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Popo laughed to herself at seeing what Poha saw, picked up her
Qi-•' grandson, stood up caressing him at her breast level, and gave Poha a t-.' i chance to see from her view. Poha's excitement at now seeing the horses , and cows gave Popo the reward for many more happy walks around the block.
As retold by Puanani Burgess from the telling by Popo
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Help us see the world through each ot he rs 0 eyesl
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Let's "talk story."
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Talking Story comes from all traditions. It is a basic tool of communicating. Talking story helps to build strong relationships and trust among people. It provides important information about how we think, feel, and dream. It displays the panorama of our cultural,
- sodaI, economic and historicaI bakc grounds. It
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become -
t}-'< aware of our own cultural beliefs and values, and shows sensitivity , and respect to other's. It helps tell about ourselves.
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-He-re's s-om-e-top-ics-w-e-cou-ld-sh-are.
-our 'Ohana, genealogy, & family life
I -our names and their meaning(s) I
I -our 'aumakua or spiritual angels I
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-our elders, kupuna, or wise folks
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-family worship, sacred places for worship
-the place we were born
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-our heroes/heroines, and why they are
-our favorite food, ethnic dishes
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IJ -our favorite place to live IJ
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fil -herbs or medicine we've found helpful
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Questions helpful in prompting us to tell our stories are:
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Where are your people from?
How many generations ago did your family/ancestors come to Hawaii?
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In what country were you born?
Describe your birthplace as best you know?
How long have you lived in Hawaii? In Wai' anae? Where were you raised?
Where does your heart calI home? ¥
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How important is your 'ohana to you? I
Describe your 'ohana?
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Do you feel a strong connections to your 'aina hanau (land of one's birth, homeland)? Do you speak your native tongue?
Have you lost touch with your cultural roots?
Do you know the rituals of your ancestors? What is your dream of becoming?
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What traits you feel best describe you?
a}-'< What scares you?
How do you overcome your fears?
Where do you generally go for help overcoming problems?
Temple, Church or other sacred place? To prayer? Favorite place, quiet and serene spot in nature?
Find a friend, confidant, doctor, case manager, or family member to talk with? Take drugs, alcohol, or medicine to help you address the problem?
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Wai'anae Coast Community Mental Health Center, Inc. '-
86-226 Farrington Highway Wai' anae, Hawaii 96792 ;
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VOYAGE TO RECOVERY
Talking Story - (Part 2)
''Kumu Ola Pono 00
Wai'anae Wellness Model
The natural condition of a person and his spiritual, earthly and social
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realm is balance. However, everyone goes through part of their life living a -
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strained relationship with one or more realms. Things get out of balance. Sometimes, there may be a multiplicity of strains occurring at the same time. Hawaiian people would try to take one strain at a time, and address
each separately, moving on step by step. Mahiki. At times, it may take manyl
efforts to identify and take care of all of the strains that is causing disharmony. ij
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One should try to maintain as much of the harmony within one's Kumu i
Ola Pono as possible. Yet one needs to recognize that just as the world is always changing, there are constantly pressures in all of the realms, which
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press upon one's Kumu Ola Pono. No matter how much we try, or how well we l
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have realigned ourselves, wellness is an ongoing process. We are constantly challenged to stay in alignment, and when we fail to do so, recovering into
; wellness is always available to each of us.
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One formulation for being well is to have a balanced relationship with all things, inside and out (internally and externally), up and down (heaven & earth), and all around (all the things and ideas which surround us). This has been an understanding from time immemorial. across all lands, among people of diverse religions, educaticm, and ethnicity.
We express this understanding here from a Hawaiian perspective. In doing so. we are cautious that even among us. there remain divergent opinions. This is not the only Hawaiian perspective and is certainly not any better them as perceived by others.
Our Kumu Ola Pono, or "model of wellness" incorporates three significant realms, each in "balance" or good relationship with one another, and with themselves. These three realms are the Akua/Aumakua (spiritual), the Kcmaka (humc.m/sodety}, and the 'Aina (Earth). This is sometimes expressed as God, Man and Nature.
When relationships are aligned between and among each of these realms, there is wellness, balance, or pono. When relationships are out of line, there is uneasiness, discord. and illness. To achieve wellness, therefore, the task is dear - keep relationships porm.
All the Elements Are Interconnected and Interdependent
2
Akua/ Aumakua Kanaka
/ ,)Observation can be an excellent teacher - if we take time
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We have seen or heard of situations where a person is not well because of his relationship with his spiritual realm.
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: Your pilikia may be with :
: your God, or your aumakua, :
: or an ancestral spirit.
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© ©
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® To get yourself into a right ®
© ©
: relationship, you may seek :
: out a priest, spiritual :
: counselor, or may resort to :
©
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: prayer and rituals, may : engage in ho oponopono, or : turn to medicine available ®
in nature. ©
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©
© ©
© ©
© There are numerous ways in ©
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© which you may return to @
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© balance with your ©
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@ spiritual realm. ©
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3
Kana ka "' Aina
We have also seen or heard of situations where one is not well because of his relationship with 'Aina.
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: Your pilikia may be because you •
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: cannot return to those places ®
@ you held dear and perhaps even @
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sacred. ©
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® You may have no land to place @
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! your feet upon, and to feel the ©
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: lepo's (dirt) energy coursing ©
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: through your body and soothing ©
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® your soul. @
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: You may long for the fresh :
® water streams you recalled :
: playing as a youth, as it flowed :
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® from the Wai' anae mountain ®
range to the ocean.
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® • ® | You can only dream of tasting again the mild sweetness of the | © ® : |
@ ® | Mountain Apples, and the tart, | : |
: | yet healing flesh of the Guava. | : |
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: You may no longer find the plants which served as your medicine, the Wapine, :
®• Ha' uT, Koli, 'Awa, Laukahi, Limu Kohu, and all those other names you can ••
barely remember today. •
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® You cannot find enough Poi to fill your hunger. You long to refresh yourself ©
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: with your 'Aina, but it seems beyond your ability to reach any more. ©
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4
Kanaka Kanaka (social circles) Disharmony often comes -from one's family, peers, community, church, or other social circles.
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® Your pilikia may come from ®
® ©
® conflicts with your love ones or ©
® any tense relationships with ®
: 'Ohana members. :
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: Your pilikia may also come from :
: lack of employment or pressure :
® from one's place of employment. 0
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® It may be due to some legal ®
: problems, concern over the world :
: at war, disagreements in politics, !
: religions, or cultural practices. :
: People's interaction and conflicts :
® with people can be a major cause ®
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® of one's sense of imbalance. ®
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® Techniques that can be helpful in bringing back a sense of balance :
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within people include group discussions, changing social :
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relationships, becoming involved and taking hold of the problem : @ and trying to solve it, having a safety net of social support, etc. : 0 @
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Most common is the disharmony within your self.
That disharmony may be within an individual, caused by stress, psychological or emotional imbalance, brain chemistry instability,
or other psychological illness.
© © © @ © © @ ® ® © © © © © @ © @ © © @ © © @ © ©
@ ©
® Keeping in harmony may employ a ®
@ ©
® number of lifestyle adjustments ®
: including training and management :
: of one's stress and recognizing :
: areas of vulnerability :
® for that individual. ®
@ @
© @
© @
© Appropriate medication may be @
@ @
@ another technique in maintaining ®
@ @
© balance. ©
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: A change in one's lifestyle, :
: improving social conditions, coming :
® to grips with the reality that one e
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® carries a condition of mental 0
: illness and will have to make :
: accommodations for that illness - :
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@ these are some of many @ @ ways in addressing the disharmony © Cl!) from within an individual. e
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Let's take some time t o describe our personal wellness model.
6
Are you satisfied with your spiritual health?
Does anything need to be done to bring balance between yourself and a spiritual element?
Do you believe you are being haunted? Do you carry a curse upon you or your family? Are you living out a prophecy? Are there unresolved grief which you carry for or because of someone who has died?
How well do you get along in your community, in your ohana, with your friends? Are there legal issues you face? What are they? Do you need employment? Are there barriers to your obtaining employment? Are you satisfied with your education background? What are your living conditions? Do you live in a safe place? Are your medical care being properly addressed?
Are you proud of yourself? If so, for what?
Do you feel "out of place" as if you are not really "home?" Would you be happier living somewhere else? Do you long for a place or for an environment other than what you now have? What are you dissatisfied with in the nature which you live?
Are you satisfied with your ability to integrate with nature? Are you happy with your environment?
7
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Hale Na'au Pono ;
Wai'anae Coast Community Mental Health Center, Inc.
:, ;, 86-226 Farrington Highway Wai'anae, Hawaii 96792 ;,
@ Telephone: (808) 696-4211 Fax: (808) 696-5516 ,
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0 KE AKAMAI NO KE HANA A NUI '0
(Losses come easily; it requires skill and wisdom to avoid them.)
' Olelo No' eau #904
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Problems, weaknesses, headaches, troubles - these pilikia are easy to come by. No effort has to be made. Troubles just seem to roll into people's lives, some troubles bigger than others, for some people, more troubles than for others. Everybody have them. The real measure of wisdom is not how well we cry over our pilikia, but how well we avoid or overcome them. The great work is how smartly we deal with our pilikia.
Pehea 'oe? How are you?
Como esta usted?
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In many different language, this polite inquiry is made as we meet and greet
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people. And in many different fashions, we hear their response. Generally, it's a pat answer - socially acceptable, not too complicated, not too involved, not too
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(Pehea "oe?) Maika" i no.
- (How are you'.>) Fm. e, thank you. -
l--' @ (Como esta usted?) Muy bien. Di--'
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Sometime, however, the answer comes out in a barrage of maladies, bad luck, and other complaints, covering a wide swath of social, physical, mental, economic, political, marital, or other issues.
"I'm depressed again, and my doctor won't see me."
''My back is so bad, I can't get out of bed, unless I take 3 cans of beer to kill the pain first."
"I can't sleep enough at home. When I get to work, I'm continually falling asleep. I think I have ghost in my house. One night I heard •.. "
"I know somebody put a curse on me, and I can't shake it. Now I have 'uhane hele (traveling spirit). I'm losing weight, don't want to eat, and my dose friends don't talk to me any more."
"I keep having this recurring dream. I want to go back home to Koma, but I can not. My family lost our land. Now, this place is not the same. I miss the graves, raising cattle, and that whole life style. Now, my whole family only sit and drink and talk about Kona, but we can not go back."
''Da lolo 1.una told me go dig up the grave. I tol him, "no way brah" and he wen say, "you no dig'um up, den go home and no come back work." So I wen dig'um up. Since den, I all da time hea voices screaming in my pepeiao. "You rotten guy, why you wen dig us up?" Sometimes I see two people who come from the bones I wen find in the graves. Dey follow me, talk to me, scold me, scream at me, make plenty trouble with me. I tell 'um, "get da hell away," "leave me alone." Sometimes I scream at 'um. But dey come back again.
The challenge is not merely to elicit all of the maladies one is experiencing, but to tell about these maladies along a sensible, holistic structure of wellness. By following cm orderly arrangement of the issues, causes, and perhaps, soh.ntions to such maladies, we can pinpoint each issue and develop a plan to address them.
Mahiki - to peel off; to pry; "Think of peeling an onion," explained Mrs. Pukui... "you peel off one layer and throw it away, so you can go on and peel off the next layer. That's rnahiki." Nana i ke Kurnu, Vol. 1, Pukui, pp. 75-76 (See Attachment J)
- ".•. detailed questioning for any helpful purpose is rnahiki. Taking a medical or psychiatric history or a social case history is rnahiki.
"This serious questioning with intent to help is the exact opposite of the purposeless "nosey" inquisitiveness called nzele.
"Knowing and discussing this difference with the Hawaiian patient or client may help change resistance to rapport." Ibid. pp. 76-77
The orderly arrangement Hale Na" au Pono uses to set out the strengths and weaknesses of an individual is the Wai" anae Wellness Model which depicts three
basic points on the triangle - 1) God(s) or the Spiritual realm, 2) man & society (kanaka), and 3) nature or environment C aina).
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Here are some ideas for initiating discussions along this Wai' anae Wellness Model:
An important area of a person's life is spirituality. Some people don't like talking with others about their spirituality. Others welcome the opportunity to do so. Let's try the subject and see how far we can get.
How important to you is your sense of spirituality? What religion do you practice?
What religion were you raised in?
Do you have any trouble with your relationship within your religion or belief system? Do you feel there is a need for some work or repair to be made in the area of spirituality?
Do you feel that your illness has anything to do with spirituality, ancestor influence, or a result of something said or done by or against a person who is now deceased?
Is there a part of spirituality you want to work on?
" Making right with ./6 Getting a
God? different name?
.# 1 Learning how to pray?
' Banish certain spirits?
,€ff Strengthening your soul?
.11! Cutting off a
curse?
J!f Addressing ancestors' needs?
.f1r Fulfilling your
obligations: individual, family, ancestral?
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Relationship To Others
Another important area is one's relationship with others. Let's explore this question of relationships, which you may have.
Do you feel that your illness has something to do with your family?
What is the root of this pilikia? Who are the people involved?
Do you have a close relationship with your ohana? What is that relationship?
Do you feel there are secrets in your ohana which adds to your illness? Can you tel I about these secrets?
Are there supports for your illness to be found in your ohana?
Do you feel your illness has something to do with other social relationships?
What is the root of it? Who are the people involved?
Are there supports for your mental illness to be found in your social relationships?
Who do you spend time with regularly?
Ohana? Congregation? Co-workers? Classmates?
Why?
Spouse/ Significant Other? Friends?
My pets? Myself?
Do you have a close relationship with your ohana?
Is there anyone that you would like to spend more time with?
Who would you say are the supportive people in your life, the ones you can talk to about problems?
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Physical Health Issues
A long time ago, in another land, a guy named Plato spoke of a healthy mind in a healthy body. This truism applies today as never before. Let's talk about this idea and how this applies to you.
Do you have any physical health problems?
Are you seeing a doctor for those health conditions?
What is your preference for means to solve your health problems?
Western medicine, Hawaiian medicine, Alternative medicines,
Pule (alone or in combination with la' au Iopa' au (medicine))?
Do you take care of your physical health? How?
Are there areas you want to work on to improve/maintain physical health?
Identify the right doctor?
Help in being consistent in taking medication?
Working with others-allowing others to help: Nurse, case managers, family members and friends?
.fl!? Do exercise regularly?
, Eat right?
What medications are you now taking?
What medications you should not take? What reaction will you have if you took these medicines.
What illnesses do you suffer from? Do you feel recovery is possible for these illnesses?
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Life Style and Daily Routine
Life style and daily routine is probably the most influential factor affecting one's health. It strikes to the very reality of one's lif e 0 setting aside all the t a lking0 promises, int e nt ions0 agreements, hopes and prayers. It's one of the most difficult aspects in someone's life. Ifs unlikely to change unless we lift it up for discussion and examination. Let's telk about it and see what changes can and should come about.
Where do you live? Do you live with family members, spouse, significant other, or roommates?
What is your typical day like?
Do you feel you need to change your current life style? What particular Iif e style do you want to change?
Stop abusive ways-learn to control anger?
Stop illegal drug use --
stop associating with wrong people;
find other friends;
get professional help?
Stop just sitting around, wasting time, letting the day pass by.
Get involved in something - school, sports, work, dancing,
etc.
Stop hanging with the guys who just do nothing all day.
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Leisure Activities/Creative Outlets
How one chooses to spend leisure time can tell a lot about lifestyle and the possibilities for developing new lifestyles. Not only is it important how one spends leisure time., but how one would like to spend such time if opportunity, resources, or friends were available for such activities. Let's talk about our leisure activities, and what else we would like to do if we could.
What do you like to do when you have extra time on your hand? What are your hobbies?
Dance hula?
Work in the fields? Paddling?
Surfing?
Fishing?
What sports do you like to do/watch on TV? Do you like to read? What kind of books?
Do you Iike to write or keep a journal? Do you like to play an instrument?
Do you like Iistening to music? What kind of music? Do you like movies or TV? Which movies or shows? Do you like to draw or do other kinds of art?
Do you like to look at artwork?
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Work Activities and Educational dasses
One's work plays a major role in how a person identifies oneself. The type of education one has 0 and the choices of classes one selects, are also strong indications of one's hopes for one's future. Let's talk about work and education.
Are you working (part-time, full-time, volunteer)? What do you do?
Are you happy with what you do? What would you like to have as a job?
Are you willing to take classes or special training to help you reach your preferred job?
Are you in a training program now? Are you taking classes?
Do you study any subjects on your own?
Are there any barriers to your getting a job or obtaining further education?
Are there ways to overcome such barriers?
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Behavioral/Emotional problems
A major focus of services to a person with serious mental illness I is to approach the problem from a medical/neurological viewpoint" looking strictly at the chemical O physical, and biological functioning of the human bodyO especially the brain. But this is not the only approach. Another is to treat oneOs mental illness strictly from the psychological standpoint. Others like to call their approach
'
"ed ect ic0 or choosing the best from whatever system works.
Do you have a serious mental illness? Can you name or describe such illness?
How often do you have symptoms which are products of your illness? What are these symptoms? What causes them to occur?
At what point would you consider your condition to elevate to a crisis? How would you identify this stage of crisis?
Do you think your pilikia is viewed as symptoms of mental illness by others? How do you feel about it?
What do you think causes your pilikia? Do you see a psychiatrist?
Do you take medication regularly? Do you think you need medication for your health problems? Do you know about the pros and cons of taking those medicines?
Are you getting Hawaiian or other alternative medicines to help you cope with your pilikia? Would you like such alternative medicines?
What do you do to help yourself prevent crisis?
How does stress off ect you? How do you deal with stress? What helps you cope with your pilikia?
What does the word "recovery" mean in relationship to your pilikia?
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Previous Experience with Peer-Based Education or Recovery Programs
There has been various types of programs offered to consumers of mental health services. In what types of programs have you been involved?
Recovery program? Self help program? Peer support program? Support group?
Recovery Education program? Alcohol or Substance Anonymous? Family Education program?
Others?
What programs have helped you in your recovery?
Pau
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p(ilyt 4
p
Balance."
"Righteousness and
For some, recovery may just be achieving a state of Pono with oneself, with one's family, with one's God, with one's 'aina. When people are "Pono" they have the feeling of contentment when things are good and right in their life. Pono teaches the attitude of positivism and optimism. Pono is a natural high without drugs or alcohol. Life itself excites: one is full of hope - seeing that the future can only get better.
let's work together to set your personal recovery goals.
What is your goal and what pathways will
you take to get there?
Useful Strategies for Recovery
People use a variety of ways to help themselves in the recovery process. If there is pilikia in the spiritual realm, someone may have the following goals:
® Spirituality
Making right with myself
s Making right with God
Making right with somebody I hurt
Making right with something I did
Knowing how to pray
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Getting rid of spirits
Strengthening my soul
Cutting off a curse
Getting a different name
Addressing ancestors' needs
Fulfilling obligations: individual, family, ancestral
An example:
"Being in touch with my spirituality is essential to me. I belonged to a church. I also found spirituality in thinking about my relationships with my ancestors, the land, and the ocean here in Hawaii. For a long time, I walked away from all of those things I was raised to respect, honor, and worship. Today, I feel adrift, lost, without a place to hook onto. I think !'II go back to my old church, hook back up with my minister, and clean up my soul by going to the ocean."
If one's pilikia is in the Kanaka realm, someone may decide on the following:
Maintaining physical health
e Taking care of the Ma'i (medical illness)
e Getting the right medication: Western, Hawaiian or alternative
o Identify the right doctor
0 Consistency in medication
Working with others - allowing others to help: Nurse, case managers, family members and friends.
e Do exercise regularly: Tai Chi, paddle, fishing, surfing
Maintain a healthy diet
An example:
"I know I'm diabetic. My mother and father are both diabetics. But I thought I was going to beat the odds. Never cared about nutrition, diet, and taking care of my weight. Now, I'm finally paying attention to my high blood sugar - only after I lost three toes, have very little feeling in my right foot, and the eye doctor told me I'll probably go blind in two years if I don't get my blood sugar under control. Today, I wish I could slap myself on my head for not listening to the doctors. But, there's always a new day coming. And I'm not going to waste any more days. I'm taking my medicine, going regularly to see the Doctor, listening to the dietician, and exercising regularly, even if it's only walking for a few miles every day. My good friend told me, "get serious or make, it's all up to you sista, nobody else."
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Changing Lifestyles
STOP abusive ways--control my anger by a) exercise; b) meditation; c) avoiding maddening circumstances; d) time-out.
STOP illegal drug use -- a) stop associating with wrong people; b) find other friends; c) get professional help.
GET direction in my life -- a) work at something: hobbies/job; b) learn something: return to school, play music, fix cars, cooking.
An example:
"I concentrate much better when I'm in a quiet environment. When things start to get noisy I get distracted and sometimes I get irritable. When I can, I seek out quieter places and situations with fewer people involved. It also upsets me to be around critical people. I avoid them when I can."
Another example:
I told her, "too late already, its my way of life, why change now. My friends are my friends, from long ago, and we into drugs only a little bit, and I work every once in a while."
Than my daughter told me, "Pop, if you feel that way, betta you go up the Pali and jump tomorrow, because you no damn good for the family. In fact, I willing to drive you up there and help you jump by pushing you over myself!"
I told her, "Honey girl, why you talk like dat to me. You no mo respect? I your dad?"
She said, "Pop, the ting is, I get mo love for my bradah's who beginning to tink living like you is o.k. I caught dem behind the house smokin weed. Dey only 8 and 10 years old, and dey said, "oh, if o.k. for Pop, must be o.k. for us. Ma is dead. I only 16, and I can not be watching dem day and night while all you do is bum around. So Pop, make it easy on us. o.k.? shape up or go kill yourself."
Dat was 3 years ago. I made new friends and dropped my old one, told my case manager, "enough fooling around, Help me through recovery." We made a plan, he stood by me. I've been clean ever since. Honey girl graduated from high school last year (the first of all my 10 kids) and enrolled in the community college. We all keep a close eye on the two boys. Pono? Yeah, real pono with my ohana now.
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Becoming Involved in Self-Help Program
Attend a support group: e.g. church group, AA, NA, United Self-help, BRIDGES, recovery groups.
Share experience
Learn useful coping skills from each other
Be a volunteer to give support to other people with similar problems
An example:
"I attend a support group for consumers at Wai'anae. It is part of a self- help program. Everyone in the group has experienced similar problems and issues that I experience. I feel very comfortable there. The other people understand what I am going through. They also have good ideas for solving certain problems."
(Contact information for a variety of self-help programs and resources is provided in the Appendix to this handout).
® Developing a support system
e Stay in touch with friends and family
Allow others to help
e Fix broken 'Ohana
An example:
"It helps me to have friends and family I can do things with and talk things over with. Sometimes I have to work on these relationships and make sure I stay in touch. So, I go talk story with them. It's better for me not to rely on just one person."
Staying Active
An example:
"I find that the more I do to stay active during the day, the better things go. I make a list each day of what I want to do. I try to list fun things as well as work things. Just being active makes me feel more confident."
® Making Time for Leisure and Recreation
An example:
"I can't just work all the time. I need time for leisure, too. I like hiking up the mountains, good exercise and fun, and sometime I go fishing with my cousin, too."
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Creativity
"I play the ukulele. It helps me to express my emotions and experiences. And sometimes I play with other people. It's very satisfying."
Following Through with Treatment Choices
"I have chosen treatment that includes a self-help group, a part-time job, and taking medication. I like to be pro-active. Following through with those things makes me feel strong, like I can handle my daily challenges."
"I'm in a peer support program, and I see a therapist once a week who helps me figure out how to deal with some of the problems in my life. Both things have been important to my recovery."
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Now, Think About the Following Questions:
What have you identified as pilikia for you? Can any of the suggestions for recovery apply to you?
Strategies for Recovery | I Already Use This Strategy | I Would Like to Try This Strategy or Develop It Further |
Self-help programs e.g. join United Self-help support programs | I | I |
Staying active e.g. make a list of things I want to do each day | I | I |
Developing a support system, e.g. stay in touch with my ohana | ||
Maintaining physical health e.g. go surfing, hiking, paddling. | ||
Being aware of the environment and know how it affects you. | ||
Making time for recreation e.g. play the ukulele, go fishing. | I | I |
Expressing creativity e.g. woodcraft, painting | ||
Expressing spirituality e.g. go to church/ temple/ join culture activities | ||
Following through with my treatment choices (such as: ) |
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What's Important to You? What Goals Would You Like to Pursue?
Take a moment and think about the following questions. You don't have to answer them right away. Just think about them for now.
What kind of friendships would you like to have?
What would you like to do with your spare time?
What kind of hobbies or sports or activities would you like to participate in?
What kind of work (paid or volunteer) would you like to be doing?
e Are there any classes you would like to take?
What kind of close relationship would you like to have?
e What kind of living situation would you like to have?
e Would you like to change your financial situation?
e How would you like to express your creativity?
What kind of relationships would you like with your family?
o What kind of spiritual community would you like to belong to?
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Some Tips About Setting Goals
People who are most effective at getting what they want often set clear goals for themselves and plan step-by-step what they are going to do.
The following suggestions may be helpful:
Break down large goals into smaller, more manageable ones.
Start with short-term goals that are relatively simple and that are likely to be achieved.
Focus on one goal at a time.
Get support in working on goals; other people's ideas and participation can make a big difference.
e Don't be discouraged if it takes longer than you think to accomplish a goal; this is very common.
If you first attempt to achieve a goal doesn't work, don't lose heart and give up. Keep trying other strategies until you find something that works. As the saying goes:" 'Umia ka hanu."-Hold the breath. (Be patient. Don't give up too easily.)
Goals Set in IMSR
Date Goal Set | Goal | Follow-up |
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Now II return to the War anae Wellness Model O How can you change or add to it recovery goals? (remember, small bites at a timel)
Pau
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There are some facts we can learn about Bipolar Disorder
Let's find out what they are...
What is Bipolar Disorder?
0 It's a major mental Illness that affects many people
e Sometimes ref erred to as manic depression
About 1 out of 100 people may develop the disorder at some point in their life
e It's no shame to have it. Bipolar disorder occurs in every country, culture, racial group and at every income level
Bipolar disorder causes pilikia that can interfere with many aspects of one's life. One of the pilikia is severe mood swings:
'°Like riding the top of the wave (mania) and getting slammed to the bottom of the sea {depression)"
Another pilikia of bipolar disorder is difficulty to know what's real and what's not real (psychotic symptoms).
2
IMPORTA NT TO KNOW
HELP IS JUST AROUND THE CORNERI
There are many reasons to be hopeful about the future:
There is effective treatment for bipolar disorder.
People with bipolar disorder can learn to manage their pilikia
People with bipolar disorder can lead productive lives.
The more you understand about the illness and take an active role in your treatment, the better you will feel and the more you can accomplish toward your life goals.
Bipolar disorder is a major mental illness that affects many aspects of a persons life.
1 out of every 100 people develops bipolar disorder at some point in their lives.
People can learn to manage the pilikia of bipolar disorder and lead productive lives.
Question: What did you know about bipolar disorder before you had a personal experience with it?
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How Is Bipolar Disorder Diagnosed?
Diagnosis is based on a clinical interview conducted by a specially trained professional, usually a doctor, sometimes a nurse, psychologist, social worker or other mental health practitioner.
Questions are asked about the pilikia you have experienced and how you are functioning in different areas of your life, such as relationships and work.
There is currently no blood test, X-ray, or brain scan that can be used to diagnose bipolar disorder.
The doctor may also request a physical exam and certain lab tests or blood tests in order to rule out other causes of your highs and lows or your inability to see between what's real and not real, such as a brain tumor or an injury to the brain.
Question: How long did it take for a mental health professional to accurately diagnose the pilikia you experienced?
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What are the signs of bipolar disorder?
Important! Remember, the signs and symptoms of bipolar disorder can be found in other mental disorders.
Specifying a diagnosis of bipolar disorder is based on a combination of different symptoms, how long they have been present, and their severity. Pilikia that occur only when a person has used alcohol or drugs are not included.
No one has the exact same pilikia or is bothered to the same degree. You may, however, recognize having experienced some of the following:
Extremely High Moods Are Called '°Mania."
n°Like I riding do top of da wave"
People who have had periods of mania have reported the following pilikia:
Feelings of extreme happiness or excitement. "I was so happy with my life; I felt like I was on top of the world. I thought the whole world loved me and worshipped me."
Feeling irritable. "I thought I had a brilliant plan for making thousands of dollars. I got very irritated when people asked questions that seemed to doubt me.
Feeling unrealistically self confident. "I sent a hand written script to Steven Speilberg. I was absolutely sure that he would buy it immediately for his next movie."
Sleeping less. "I felt like I only needed two hours of sleep a night. I was too excited to sleep any more than that."
Talking a lot. "People told me I was talking all the time; they couldn't get a word in edgewise. I couldn't seem to stop myself because I had so much to say."
Having racing thoughts. "My head was so full of thoughts I couldn't keep up with them."
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Being easily distracted. "I couldn't concentrate on what my English teacher was saying, I was distracted by every other sound - the ticking of the clock, the air conditioner humming, a car driving by, someone walking by in the hall, a bird singing outside the window. It was very overwhelming."
Being extremely active. "Sometimes I would work 20 hours a day on my inventions. Or I would rearrange every stick of furniture in my house - then change it again the next day."
0 Having bad judgment. "I thought nothing bad could happen to me, so I spent everything in my bank account, borrowed from everyone I knew, then ran up all my charge cards. I also had a one night stand with someone that I didn't know at alI - I was lucky he didn't have AIDS or something."
Extremely Low Moods Are Called "Depression.' 0
08Den I smashed do bottom. ""
'°Ho bra, you wen eat plenty sand for lunch"
Sad mood. "I couldn't see anything positive in my life. Everything seemed dark and negative.
0 Eating t00 little or too much. "When I am depressed, I lost all interest in food. Nothing looks good and I hardly eat anything. I lost ten pounds the last time."
e Sleeping too little or too much. "I had a lot of trouble falling asleep at night. I would lay awake for hours, tossing and turning. Then I would wake up at 4:00 a.m. and not be able to go back to sleep. Other people I know with depression have the opposite problem. They feel like sleeping all the time - they spend 12 hours or more a day in bed."
@ Feeling tired and low energy. "I dragged myself to work each morning, but I could barely answer the phone once I got there. Everything seemed like such an effort."
@ Feeling helpless, hopeless, worthless. "I broke up with my boyfriend because I thought I was a loser and he shouldn't be stuck with me. He deserved better. It seemed like nothing I did turned out right. I saw nothing but heartache in my future."
Feeling guilty for things that aren't your fault. "I started feeling responsible for
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all kinds of things: my brother's having cerebral palsy, the car accident that happened in front of my house, even the hurricane that blew the roofs off the buildings down in Florida. Somehow I thought it was all my fault."
Suicidal thoughts or actions. "When I reached the bottom, I felt that the only way out was to leave this world. I thought my wife and kids would be better off without me. Luckily, I didn't do anything to hurt myself, although I considered it."
Trouble concentrating and making decisions. "It took me over an hour to read a one page letter from my bank. I couldn't keep my mind focused. And one day I couldn't go to work because I couldn't decide what shirt to wear."
Symptoms Which Make It Hard to Know What's Real Are Called "Psychotic Illness.00
Some people with bipolar disorder have psychotic pilikia. They have described the following experiences:
e Hearing, seeing, feeling or smelling something that is not actuc:dly there (hallucinations). "I heard different kinds of voices. Sometimes the voices were o.k., just making comments like "now you're eating lunch." But sometimes the voices said things like "you're stupid; no one wants to be friends with such a loser."
e Or they might say scary things about other people, "he has a knife and wants to kill you."
Having very um.1suc::d or unrealistic beliefs that are not shared by others in your culture or religion (delusions). "I was convinced that I had special mental powers that could stop missiles in their tracks. I thought the FBI was after me because they wanted to control these powers. I even thought the TV was talking about this."
Confused thir1king (thought disorder). "I used to try to tell my sister what I was thinking, but I would jump from topic to topic and she told me she had no idea what I was talking about."
Question: Which of the pilikia have you experienced? You can use the following checklists to record your answer.
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Pilikia of Mania
II Had This IPilikia of Mania Pilikia | !Example I | |
Feeling Extremely Happy or Excited | ||
Feeling Irritable | ||
Feeling Unrealistically Self Confident | ||
Sleeping Less | ||
Talking Alot | ||
Having Racing Thoughts | ||
!Being Easily Distracted II I | ||
!Being Extremelr Active II I | ||
!Having Faulty Judgment II I |
Pil ikia of Depression
Pilikia of Depression | I Had This Pililda | Example |
Sad Mood | ||
Eating Too Little or Too Much | ||
Sleeping Too Little Or Too Much | ||
Feeling Tired and Low Energy | ||
Feeling Helpless, Hopeless, Worthless | ||
Feeling Guilty for Things That Weren't My Fault | I | I |
Suicidal Thoughts or Actions | ||
Trouble Concentrating & Making Decisions |
Pil ikia of Psychosis
Symptom of Psychosis | I Had This Symptom | !Example | I |
Hearing, Seeing, Feeling or Smelling Something That is Not Actually Present | I | I | |
!confused Thinking II I Having Very Unusual or Unrealistic DI | |||
Beliefs That Are Not Shared by Others in My Culture | I |
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Bipolar Disorder is NOBODY'S Fault
Neither you nor your family members or anyone else caused your disorder. Scientists believe this pilikia is caused by a chemical imbalance in the brain. These chemicals are called "neurotransmitters." It sends messages around the brain. When they become imbalanced, they can cause extreme shifts in your mood. This chemical imbakmce can also cause the brain to send messages that contain wrong information.
What Causes the Chemical Imbalance?
Scientists do not know what causes this chemical imbalance, but they believe that whatever causes it happens before birth. This means that some people are born at risk for developing bipolar disorder and then develop pilikia at a later age.
Does Stress Play A Role?
YES0 it is believed to play a role in the onset and course of bipolar disorder. The theory of how vulnerability and stress interact with each other is called the "stress vulnerability model." More information on this subject is provided in the handout "Talking Story (Part 2)-Kumu Ola Pono - the Wai'anae Wellness Model 00
Many questions about bipolar disorder remain unanswered.
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: Stress is also believed to play a role in the onset of bipolar and the :
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: course of the disorder. :
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Question: What other explanations have you heard about what causes bipolar disorder?
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What is the course of bipolar disorder? What happens after you first develop this pilikia?
People usually develop bipolar disorders as teenagers or young adults (appx. age 16- 30).
e People can also have their first symptoms when they are in their 40's or 50's.
People vary how often they have this pilikia, the severity and how much the disorder interferes with their lives.
It affects people in very different ways; some have a milder form of the disorder and only have it a few times in their lives. Others have a strong form of the disorder and have several episodes, some of which require hospitalization.
& Associated with intense emotional life events, pushing the "highs" higher and the "lows" lower. If it tends to get worse, this is usually referred to as a "symptom exacerbation" or an "acute episode" or a "relapse."
® Some relapses can be managed at home, but others may require hospitalization to protect the person or others.
With effective self-management, case management, therapy, and medication management, most people with bipolar disorder can reduce their pilikia and live productive,
meaningful lives.
Questions:
What has been your experience with your pilikia?
How have you managed your pilikia?
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Who do you turn to for Kako"o?
Do you self-medicate or resist taking medication?
What is your plan for treating your pilikia?
Question: Have you ever experienced stigma because of psychiatric disability?
What are some of the steps you can take to manage your pilikia?
By reading this going thru this pathway, you are already taking an important step, which is to learn some practical facts about your disorder.
Other important steps include:
Learning how to cope with stress
e Building a circle of friends
Developing a crisis prevention plan
Using medication effectively
Learning how to cope with pilikia
e Getting your needs met in the mental health system These steps will be covered in the other recovery pathways
What you do makes a difference in your recovery. |
There are steps you can take to manage psychiatric pilikia effectively. |
11
Summary Of The Main Points About Bipolar Disorder
o Bipolar disorder is a major psychiatric disorder that affects many aspects of a person's life.
e 1in every 100 people develops bipolar disorder at some point in his or her life.
People can learn to manage the pilikia of bipolar disorder and lead productive lives.
e Bipolar disorder is diagnosed by a clinical interview with a mental health professional.
e The major pilikia of bipolar disorder are mania, depression, psychotic pilikia. e No one has exactly the same pilikia or experiences them to the same degree. e Bipolar disorder is nobody's fault.
e Scientists believe that bipolar disorder is caused by a chemical imbalance in the brain.
e Bipolar disorder tends to be episodic, with pilikia coming and going at varying levels of intensity.
There are countless positive examples of people with bipolar disorder who have contributed to society.
Stigma refers to negative opinions and attitudes about mental illness.
e What you do makes a difference in your recovery.
e There are steps you can take to manage psychiatric pilikia effectively.
PAU
12
Prepare your shipu.
Who You Are -- Mind, Body, Spirit - - Influence How You Sail.
There are some facts we can learn about Schizophrenia
Let's find out what they are...
2
There are countless positive examples of people with schizophrenia who have contributed to society
"I was about 16 at the time that I underwent a horrifying experience. . . One late morning, I began hearing sounds of evil chaos . . . The chaos may have been coming from demons or from my mind. I do not know . . . round that time, I was starting to take drugs. . . took an overdose of belladonna and spent three days in the psychiatric ward of Tripler Army Medical Center, tied down with four-point restraints and undergoing convulsions. . . I have been hospitalized 17 times, but I have not been hospitalized since I left the Hawaii State Hospital in January 1996. . . Now, at the age of 52, I have survived. . . I plan to continue writing and sharing with my peers who are also mentally ill. . . because it makes me feel good."
(Zenke Paul Sak@mizu shared his story about coping with mental illness in the
Honolulu Advertiser, 8th July 2004.
Zenko Paul Sakomizu is a writer living in Hawai'i who has struggled with schizophrenia and homelessness for years. He writes about his recovery so that @ther individuals with schizophrenia can learn from his experience and he advocates for pilikia management through medication and psychological help).
With effective treatment most people with schizophrenia can reduce their pilikia and live productive and meaningful lives
3
Introduction
This handout provides information about schizophrenia. Facts are given about how we know someone has schizophrenia, the pilikia caused by this disorder, and how common it is, and the possible courses of the disorder. Several examples are included of people who have schizophrenia and have made positive contributions to society.
What is Schizophrenia?
® It's a major mental illness that affects many people
About 1 out of 100 people develops schizophrenia at some point in their life
It's no shame to have it; Schizophrenia occurs in every country, culture, racial group and at every income level
Schizophrenia causes pilikia that can make it dif-f icult for you to do things you normally do.
Some pilikia make it difficult to know what's real and what's not real. These pilikia have been described as being similar to "dreaming when you are wide awake.00
Other pilikia can make it difficult for you to focus, to get motivated, or to enjoy yourself.
IMPORTANT TO KNOW
HELP IS JUST AROUI\ID THE CORNER!
There are many reasons to be hopeful about the future: There are treatments that work for schizophrenia.
People with schizophrenia can learn to manage their Pilikia.
People with schizophrenia can lead productive lives.
4
The more you understand about the illness and take an active role to manage your pilikia, the better you will feel and the more you can accomplish toward your life goals.
Schizophrenia is a major mental illness that affects many aspects of a persons life
1 out of every 100 people develops schizophrenia at some point in their lives
People can learn to manage the pilikia of schizophrenia and lead productive lives
Question: What did you know about schizophrenia before you
had personal experience with it?
How Do You Know If Someone Has Schizophrenia?
Schizophrenia is diagnosed based on a clinical interview conducted by a specially trained professional, usually a doctor, but sometimes a nurse, psychologist, social worker or other mental health practitioners.
Questions are asked about the pilikia you have experienced and how you are functioning in different areas of your life, such as relationships and work.
The doctor may also request a physical exam and certain lab tests or blood tests in order to rule out other causes of symptoms, such as a brain tumor or an injury to the brain.
There is currently no blood test, X-ray, or brain scan that can be used to diagnose schizophrenia.
5
Question: How long did it take for a mental health professional to accurately diagnose the pilikia you experienced?
What Are The Signs of Schizophrenia.?
Important/ Remember, the signs and symptoms of schizophrenia can be found in other mental disorders.
Specifying a diagnosis of schizophrenia is based on a combination of different symptoms, how long they have been present, and their severity. Pilikia that occur only when a person has used alcohol or drugs are not included.
No one has the exact same pilikia or is bothered to the same degree. You may, however, recognize having experienced some of the following:
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"Hallucinations00 Are False Perceptions
This means that people
Hear, See, Feel or Smell something that is not actually there.
"Hearing Voices" Is The Most Common Type of Hallucination.
Some voices might be pleasant, but many times they are unpleasant, saying insulting things or calling people names.
When people hear voices, it seems like the sound is coming in through their ears and the voices sound like other human voices. It sounds extremely real. This experience is different from hearing yourself think.
Some Examples:
,P " The voices have been bothering me all night."
r7 "A voice kept criticizing me and telling me that I was a bad person."
r7 "Sometimes I heard two voices talking about me and commenting on what I was doing."
Many People Also Experience 'Visual Hallucinations". Which Involve
Seeing Things Which Are Not There.
Some Examples:
ff,,? "Once I saw a lion standing in the doorway to my bedroom. It looked so real."
.t? "I thought I saw fire coming in the window. No one else saw it."
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7
"Delusions" Are False Be lie fs
This means that people have strong beliefs that are firmly held and unshakeable, even when there is evidence that contradicts them, and these beliefs are very individual, and not shared by o· hers in their culture or religion.
Delusions seem very real to the person experiencing them, but they seem impossible and untrue to others.
Some Examples:
P "I believed that someone was trying to poison me."
P "I was convinced that the TV was talking about me."
P "I believed that I was fantastically wealthy, in spite of the balance in my bank account."
.P "I thought that people were reading my thoughts."
f? "No matter what the doctor said, I was convinced that I had parasites."
A "Thought Disorde r 08 Is Confused Thinking
This pilikia makes it difficult to stay on the topic, use the correct words, form complete sentences, or talk in an organized way that other people can understand.
Some Examples:
P "People told me I jumped from topic to topic. They said I wasn't making sense."
tF- "I used to make up words when describing things to my brother, but he said he didn't understand what I was saying."
,1;? "I'd be talking and suddenly I would stop in the middle of a thought and couldn't continue. It was like something was blocking my thought."
"Cognitive Difficulties" Are Problems with Concentration. Memory and Abstract Reasoning
This means that people might have problems with paying attention, remembering things, and understanding concepts.
8
Some Examples:
"v "I had trouble concentrating on reading or watching TV."
ft' "I couldn't remember plans or appointments."
P "I had problems understanding complicated ideas."
A " Decline in Social or Occupational Functioning" Means Spending Much Less Time Socializing with Other People or Being Unable to Work or Go to School
This pilikia is especially important, because it must be present for at least 6 months in order to diagnose schizophrenia. It is also important because it has a big impact on people being able to carry out their kuleana, such as taking care of themselves or their children or their household responsibilities.
Some Examples:
fffl "It became very uncomfortable to spend time with people. I went from loving to spend time with my ohana to dreading it and avoiding it whenever I could."
f§1 "I couldn't do the cooking and cleaning any more. Everyday chores became absolutely too much to me."
tfi.? "My job was very important to me, but it became very hard for me. I tried very hard, but I had trouble with even the most basic tasks. It was very hard to explain to anyone."
"Disorganized Or Catatonic Behavior" Refers to Two Different Ext r emes of Behavior . . . Both Are Relatively Rare
"Disorganized Behavior" is behavior that appears random or purposeless to others. "Catatonic Behavior" refers to when a person stops almost all movement and is immobile (or almost completely immobile) for long periods of time.
9
An Example of Disorganized Behavior:
"I used to spend whole days moving all the pots and pans from the kitchen to the basement to the bathroom then back to the kitchen. Then I'd start all over again."
An Example of Catatonic Behavior:
"I don't remember this, but my brother told me that before I started getting help, I used to sit in the same chair for hours and hours. I wouldn't move a muscle, not even to take a drink of water."
''Negative Symptoms" Are the Lack of Energy, Motivation. Pleasure and Expressiveness
People would have problems with starting and following through with plans, being interested in and enjoying things they used to like, or have problems with expressing their emotions to others with their facial expression and voice tone. While these pilikia may be accompanied by feelings of sadness, often they are not.
Some Examples:
"I stopped caring about how I looked. I even stopped taking a shower." "It was so hard to talk story with people, even when I liked them."
"I didn't have the energy to go to work or go out with friends or family or follow through with plans."
f!j' "Things that used to be fun, like surfing and fishing, didn't seem fun anymore."
"People told me they couldn't tell what I was feeling. They said they couldn't read my face. Even when I was interested in what they were saying, they thought I was bored or not interested.
No one has exactly the same pilikia or experiences them to the same degree
10
Question: Which of the pilikia have you experienced? You can use the following checklist to record your answer.
Pilikia | I Had This Pilikia | Example of What Happened to Me |
Hallucinations (hearing, seeing, feeling or smelling something that is not there) | I | |
Delusions (having a strong belief that is firmly I held in spite of contrary evidence) I | ||
Thought disorder (difficulty with thinking clearly and expressing myself clearly) | I | |
Cognitive Difficulties (problems with concentration, memory and reasoning) I | ||
Disorganized or Catatonic Behavior (random behavior or remaining motionless) | I | |
Negative Pilikias (lack of energy, motivation, oleasure, and emotional expressiveness) | ||
Decline in Social or Occupation Functioning (less time socializing, problems doing work) | I | |
I | ||
Other I | I |
What Causes Schizophrenia?
Schizophrenia is Nobody's Fault
This means that you did not cause the disorder, and neither did your family members or anyone else.
Scientists believe that - he pilikia of Schizophrenia are caused by a chemical imbalance in the brain/chemicals called "neurotransmitters" send messages in the brain. When they are out of balance, they can cause the brain to send messages that contain wrong information.
Scientists do not know what causes this chemical imbalance, but they believe that whatever causes it happens before birth. This means that some people are born at 11
risk for developing Schizophrenia and then develop pilikia at a later age.
Does Stress Play A Role?
YES, it is believed to play a role in the onset and course of Schizophrenia. The theory of how vulnerability and stress interact with each other is called the "stress vulnerability model." More information on this subject is provided in the handout "Pathway 4-A Look at the Stress - Vulnerability Model.
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: Many questions about Schizophrenia remain unanswered. :
about the illness. :
: There are many research projects underway to try to learn more :
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Question: What other explanations have you heard about what causes Schizophrenia?
The Course of Schi&:ophrenia
What Happens After You First Develop Pilikia?
Most people develop Schizophrenia as teenagers or young adults, around age 16 to age 30.
People vary in how often they experience the pilikia, the severity and how much these pilikia interferes with their lives.
Schizophrenia affects people in very different ways.
!iTu Some people have a milder form of the disorder and only experience the pilikia a few times in their lives.
Other people have a stronger form and have several episodes, some of which require hospitalization.
12
Some people experience the pilikia almost constantly, but do not have severe episodes that require hospitalization.
- When pilikia reappear or get worse, this is usually referred to as having a crisis. (More information on this subject is provided in the handout "Pathway 9-Building Strength and Reducing Crises")
Some crises can be managed at home, but other crises may require hospitalization to protect the person or others.
With effective self-management, case management, therapy, and medication, most people with
Schizophrenia can reduce their pilikia and live productive,
meaningful lives.
Questions:
What has been your experience with your pilikia?
How have you managed your pilikia?
Who do you reach out to for kokua?
Do you self-medicate or resist taking medication?
What is your plan for treating your pilikia?
13
Examples of People Who Have Schizophrenia
John Nash (1928 to present) is an American mathematician who made discoveries in math that had very important applications in the field of Economics. He won the Nobel Prize for Economics in 1994. His story is told in A Beautiful Mind, a book that has also been made into a movie.
Patricia E. Deegan Ph.D. is a psychiatric survivor, first diagnosed with Schizophrenia as a teenager. She received her doctorate in clinical psychology from Duquesne University in 1984. She is an activist in the consumer/survivor/ex patient movement and a co-founder of the National Empowerment Center Inc. She was a keynote speaker at the 2005 Best Practices Conference in Honolulu, Hawaii speaking on the topic of recovery from mental illness.
Zenko Paul Sakomizu is a writer living in Hawai'i who has struggled with Schizophrenia and homelessness for years. He writes about his recovery so that other individuals with Schizophrenia can learn from his experience and he advocates for pilikia management through medication and psychological help.
Other people who have developed Schizophrenia are not famous, but are quietly leading productive, creative, meaningful lives:
Mr. X: works in an art supply store. He has a close relationship with his two brothers and goes bowling with them regularly. He likes to draw and plans to take an evening art class in the coming year.
Ms. Y: is married and has two children in elementary school. She participates in the home and school association and enjoys gardening.
Mr. Z: lives in a group home and volunteers at the zoo. He used to need frequent hospitalizations, but has successfully stayed out of the hospital for 2 years. He is looking for paid employment.
There are countless positive examples of people with Schizophrenia who have contributed to society
Question: Do you know other people with Schizophrenia?
If, so, what are some examples of their personal strengths?
14
What are some of the steps you can take to manage your pilikia?
By reading this handout, you are already taking an important step, which is to learn some practical facts about your disorder.
Other important steps include: Learning how to cope with stress
%lJ Building a circle of friends
%lJ Developing a crisis prevention plan Using medication effectively
%lJ Learning how to cope with pilikia
Getting your needs met in the mental health system
These steps will be covered in the other recovery pathways
What you do makes a difference in your recovery.
There are steps you can take to manage psychiatric pilikia effectively.
15
Summary of the Main Points about Schizophrenia
Schizophrenia is a major psychiatric disorder that affects many aspects of a person's life.
1in every 100 people develops Schizophrenia at some point in his or her life.
e People can learn to manage the pilikia of Schizophrenia and lead productive lives.
Schizophrenia is diagnosed by a clinical interview with a mental health professional.
e The major pilikia of Schizophrenia are:
Hallucinations
Delusions
Thought Disorders
Cognitive Difficulties
Decline in Social or Occupational Functioning
Disorganized or Catatonic Behavior
Negative Symptoms (lack of energy, motivation, pleasure or emotional expression)
e No one has exactly the same pilikia or experiences them to the same degree.
e Schizophrenia is nobody's fault.
o Scientists believe that Schizophrenia is caused by a chemical imbalance in the brain.
Schizophrenia tends to be episodic, with pilikia coming and going at varying levels of intensity.
There are countless positive examples of people with Schizophrenia who have contributed to society.
" Stigma refers to negative opinions and attitudes about mental illness.
What you do makes a difference in your recovery.
There are steps you can take to manage psychiatric pilikia effectively.
16
Prepare your ship...
Who You Are - - Mind, Body, Spirit -Influence How You Sail.
·............................................................................................................·
Introduction:
Depression can knock you out! It can hit so hard, you don't realize what happened until all around you, things fall apart, and worse of alI, you don't give a damn. Many times we don't know how to get out of this dark cave called depression. Falling into it seems to be
easier than climbing out.
This pilikia is an illness the Hawaiians call "kaumaha." It's not just our being molowa or lazy. It's not any bad upbringing, or bad character. Kaumaha can be handled - there is a way to climb out of the cave!
There are some facts we can learn about Kaumaha
It is a major illness that impacts many aspects of a persons life.
15-20 people in every 100 {almost 1 out of 4) have a period of serious depression at some point in their lives.
2
Kaumaha can be managed. People can learn to lead productive lives.
Kaumaha is nothing to be ashamed. Letting it get out of hand and ruin one's /ife is lolo! (stupid)
Depression Causes Pilikia That Can Interfere With Many Aspects of
People I s Lives:
e It causes people to have extremely low moods; they feel very sad or "blue" and they feel they can't get out of it.
@ Some folks lose their appetite, cannot sleep or sleep too much. Some just cannot find energy to do anything.
® Kaumaha can throw work and social life topsy-turvey.
HELP IS JUST AROUND THE CORNER!
(Eh Bra, look, get steps fo climb out the cave)
There are many reasons to be hopeful about the future:
There is effective treatment for depression
People with depression can learn to manage their pilikia
People with depression can lead productive Iives
The more you understand about the illness and take an active role in your treatment, the better you wi11 feel and the more you can accomplish toward your life goals.
"A'OHE PU0 U KI'EKI'E KE HO'A'O 'IA E PIQI 00
(No cliff is so tall it cannot be scaled.)
'Olelo No'eau, Puku'i, #209
3
Things can change. Believe in yourself.
Question: What does Depression mean to you?
How Is Depression Diagnosed?
Diagnosis is based on a clinical interview conducted by a specially trained professional, usually a doctor, sometimes a nurse, psychologist, social worker or other mental health practitioners.
Questions are asked about the pilikia you have experienced and how you are functioning in different areas.
There is currently no blood test, :X- ra y1 or brain scan that can be used to diagnose depression.
The doctor may also request a physical exam and certain lab tests or blood tests in order to rule out other causes of the pi'likia, such as a brain tumor or an injury to the brain.
Question? How long did it take for a mental health professional to
accurately diagnose the pilikia you experienced?
4
Sad Mood. negative."
What Are The Signs of Depression?
Extremely low moods are called "Depression."
"I see no good things in my life. Everything looks dark and
Eating Too Little or Too Much. "When I am depressed, I lose all interest in food. I don't eat anything. I know this is no good for my health but I just don't feel like eating"
Sleeping Too Little or Too Much. "I had a lot of trouble falling asleep at night. I would lay awake for hours, tossing and turning. Then I would wake up at 4:00 a.m. and not be able to go back to sleep. Other people I know with depression have the opposite problem. They feel like sleeping all the time - they spend 12 hours or more a day in bed."
Feeling Tired and Low Energy. "I dragged myself to work each morning, but I could barely answer the phone once I got there. Everything seemed like such an effort."
o Feeling Helpless, Hopeless, Worthless. "I broke up with my boyfriend because I thought I was a loser and he shouldn't be stuck with me. He deserved better. It seemed like nothing I did turned out right. I saw nothing but heartache in my future."
Feeling Guilty For Things That Aren't Your Fault. "I started feeling responsible for all kinds of things: my brother's having cerebral palsy, the car accident that happened in front of my house, even the hurricane that blew the roofs off the houses in Ka.uai. Somehow I thought it was all my fault."
Suicidal ·rhoughts or Actions. "When I reached the bottom, I felt the only way out was to leave this world. I thought my wife and kids would be better off without me. Luckily, I didn't do anything to hurt myself, although I considered it."
Trouble Concentrating and Making Decisions. "It took me over an hour to read a one page letter from my cousin. I couldn't keep my mind focused. And one day I couldn't go to work because I couldn't decide what shirt to wear."
5
Remember, the signs and symptoms of depression can be found in other mental disorders
Specifying a diagnosis of depression is based on a combination of different symptoms, how long they have been present, and their severity. Pilikia that occur only when a person has used alcohol or drugs are not included.
Question: Which of the pilikia have you experienced?
You can use the following checklist to record your answers.
Pilikia of Depression-Checklist
I | Kaumaha | I Had This Pilikia | Example | |
lsad Mood | ||||
!Eating Too Little Or Too Much | ||||
lsleeeing Too Little or Too Much | ||||
!Feeling Tired and Low Energy | ||||
!Feeling Heleless, Hoeeless, Worthless | ||||
Feeling Guilty for Things That Weren't My Fault | ||||
!suicidal Thoughts or Actions I | ||||
Trouble Concentrating & Making Decisions | I I | |||
lather | II | I | ||
lather | II | I |
What Causes Depression?
It is extremely important to know that Depression is not your fault. Sometimes when people are depressed they start to think that they caused it. This is not true. Scientists believe that Depression is caused by a chemical imbalance in the brain. Chemicals called
6
"neurotransmitters" send messages in the brain. When these chemicals are out of balance, they can cause low moods.
What Causes the Chemical Imbalance?
It is not yet known what causes this chemical imbalance, but they believe that whatever causes it happens before birth. This means that some people are born at risk for developing depression and then develop pilikia at a later age.
The experience of a major stress or loss, such as losing a loved one, or being the victim of abuse or violence, can increase the chances of a person developing depression.
Stress also appears to play a role in the course of depression.
Many questions about depression remain unanswered. There are many research projects underway to try to learn more about the disorder.
With effective self-management, case management, therapy, ana medication management, most people with depression can reduce their pilikia and live productive, meaningful lives.
Questions:
How have you managed your symptoms? Who do you reach out to for kokua?
Do you self-medicate or resist taking medication? What is your plan for treating your pilikia?
7
Examples of People Who Have Depression
Winston Churchill: He was the Prime Minster of England during WWII and led his country to victory.
Mike Wallace: He is an American television journalist, well-known for conducting interviews on the show, "60 Minutes."
Other people who have developed depression are not famous, but are quietly leading productive, creative, meaningful lives:
Mr. Y is a college student who plays on the soccer team.
Ms. Z is married and the mother of a 2-year-old son. She works at home and cares for her child.
8
Summary of the Main Points About Depression
e Depression is a major psychiatric disorder that affects many aspects of a person's life.
e 15 to 20 people in every 100 have a period of serious depression at some time in their lives.
e People can learn to manage the pilikia of depression and lead productive lives.
e Depression is diagnosed by a clinical interview with a mental health professional.
e The pilikia of depression include:
Sad mood
Eating too little or too much
Sleeping too little or too much
Feeling tired or low energy
Feeling helpless, hopeless, or worthless
Feeling guilty for things that aren't your fault
Suicidal thoughts or actions
Trouble concentrating and making decisions
e No one has exactly the same symptoms or experiences them to the same degree.
e Depression is not your fault.
Scientists believe that depression is caused by a chemical imbalance in the brain.
e Depression tends to be episodic, with pilikia coming and going at varying levels of intensity.
., There are countless positive examples of people with depression who have contributed to society.
What you do makes a difference in your recovery.
9
'
-1 I
I I
Alcohol &
Drug Use Medication
Biological Vulnerability to psychiatric pilikia
Coping
Meaning activities
Healtyh Lifestyle
Suppo,rtive relationships
Identify stressors
§ t ress-Vuln.er abmtv Model
--- - --------- - ------ -- - - - - - - -------- -- --- ---- ------- -- - - -- ----------------- I
One opinion many scientists believe in is the concept of "biological vulnerability."
Some people are born with, or acquire early in life, a tendency to develop specific medical problems. Some problems could be schizophrenia, bipolar disorder, or depression. Neurotransmitters in the brain, they believe, cause these problems.
One study scientists are conducting is the human genome project, researching genetic factors as they relate to health, including mental illness. Others question this genetic explanation for mental illness, pointing out that in a single family of people with the same genes, one person may suffer from a mental illness while another family member, even an identical twin, may not have such an illness.
Another biological approach is that rather than genetics, early exposure to virus by a baby or a fetus, may cause vulnerability in an individual. It is unclear if early exposure to a fetus by alcohol or street drugs will cause the child to have vulnerability to mental iIlness.
Yet another cause for mental illness may be chemical imbalance in one's brain.
2
How Can This "Stress - Vulnerability ModeiQI Apply To You?
All these possible biological causes of mental illness we have mentioned above may lead us to another question. What causes such biological factors from occurring?
Could it be spiritual forces? Is this an act of "god" or the "devil"? Is one's mental illness a curse spoken a hundred years ago?
Could the cause be environmental forces? Is it because the 'aina is not clean? Is it toxics in the air, water and soil?
Could the cause be social? Does mental illness develop because of societies treatment of one who is different? The effect of being shunned, of being laughed at, or of being picked upon over time?
Could the cause be biological forces? Does psychiatric pilikia develop because of family history of mental illness?
What do you think is the cause for mental illness? How do you think you could help people avoid this illness or become well again?
If the cause is spiritual, what are the ways in which one could return to becoming well?
If the cause is environmental, what could one do to improve his condition?
And if the cause is social, is there any particular profession you would recommend one could get help from?
What if the cause is biological, how can one return to wellness?
Have you considered reasons how you might fall outside of the wellness relationship? If so, how could you best return to wellness?
3
Reducing Stress Can Help You Recover From Your Pilikia
Are there any stress factors you can identify which may cause you to have pilikia?
Do you face the following stressful situations? And if you do, how do you address them?
- Too much to do and not enough time to do it.
Nothing to do but sit around all day or deal with meaningless activities.
Tense relationships, especially when people around you are always arguing, angry, criticizing, or picking on you for nothing.
Major life changes such as losing a good friend or loved one, moving from home, starting a new job, getting married or having a child.
Unemployment.
- Homelessness.
Financial problems.
Legal problems.
Abusing drugs or alcohol. Being the victim of a crime. Unhealthy living conditions. Rejections constantly.
Disrespected, teased, and treated as worthless.
Here are some solutions used by others whenever they face stressful conditions: Seek out supportive relationships where you feel comfortable talking about stress.
Identify past stressful situations. Think how you could handle such situations (or
avoid them) the next time you see it coming.
Set reasonable expectations for yourself - Don't demand too much or settle for too little.
Engage in meaningful activities and not just waste time stuff. Eat well, rest adequately, exercise regularly.
Avoid loud, argumentative, and mean people.
Be kind to yourself, honest in your criticism, and never mean to self or others. Keep balance in your life - be 'oluolu with all things and people as much as you can. Express lokahi with your family and associates
Practice aloha in your thoughts and your actions, forgiveness with yourself and with others.
Please read the handout "Coping with Stress and Common Problems" and share your opinion on it
4
Let 's work together and creat e a persona l "S t r es s Adjus t me nt " cha rt :
Strategy to reduce sources of stress | I use this strategy effectively | I could use or improve on using this strategy |
Be aware of situations that were stressful in the past | ||
Set reasonable expectations of myself | ||
Engage in meaningful activities | ||
Maintain good health habits | ||
Seek out supportive relationships | ||
Avoid situations with arguments or criticism | ||
Not judge myself too harshly and give myself credit for my positive side |
Review: Let's consider that "stress-vulnerability" model once again. Of those four areas that pull one off the course of wellness, or put a person back on coL1rse, which are the areas
which affect you most?
---
---
---
Coping Medication Stress Substance Abuse
What are the strategies, or goals, you believe appropriate for you in addressing each one of these areas?
Are these goals part of your Mental Health Treatment /Recovery plan?
5
Here is another approach one can use in setting goals in a treatment or recovery plan:
Some goals in treatment have been?
Figure out what's the problem.
Figure out what causes the problem.
Figure out how to remove or lessen the cause of the problem.
Figure out how to accept the problem and move on.
Ignore the problem for the time being. (Especially if there are multiple problems to handle.)
What is to be treated?
The problem?
The cause of the problem?
Getting to live with the problem?
The person with the problem?
If the cause of the problem is a chemical imbalance in one's brain, what kinds of treatment may be appropriate?
Medication *
Stop abusing drugs, including alcohol and tobacco**
Change in Diet
Exercise
Improved overall health
Operation (for some people)
Pleasurable activities
*The education handout "Using Medication Effectively" provides more information about how to get the best results from medication.
** Abusing drugs have been found to have a direct effect on the neurotransmitters in the brain.
6
If the cause of the problem is the bad vibes from one's family members6 what kinds of treatment may be appropriate?
Ho' oponopono
Pule (Prayer) and' Oli (Chant)
Court action
Family counseling
Talk to a kahu, minister, or spiritual leader
Stay away until things cool off
Change your attitude and hope that others attitude change along with yours
Find out why the bad vibes and remove the cause for those vibes
Go fishing, bring home something to be shared with the family
J. Pick up some fruits or other things that may be appreciated and bring them home.
One last time - let's
Review: Consider that "stress-vulnerability" model once again. Of those four areas that pull one off the course of wellness, or put a person back on course, which are the areas that affect you most?
_Coping
Medication Stress Substance Abuse
What are the strategies, or goals, you believe appropriate for you in addressing each one of these areas?
Are these goals part of your Mental Health Treatment/Recovery plan?
7
Coping With Stress Also Means Preparing For It
Life events refer to experiences such as moving, getting married, the death of a loved one, or having a baby. Some life events are more stressful than others. To see how many life events you have experienced in the past year, complete the following checklist:
Life Events Checklist
Put a check mark next to each event that you have experienced in the last year:
Moving
Getting married
_New baby
Divorce or separation
_Injury
Illness
_New job
_ Loss of a job
Inheriting or winning money
Financial problems
Injury or illness of a loved one
Death of a loved one Victim of a crime
_ Legal problems
New boyfriend or girlfriend
Broke up with a boyfriend or girlfriend
_ Stopped smoking Went on a diet
New responsibilities at home
New responsibilities at work
No place to live
Hospitalization
Drinking or using street drugs caused problems Other:---------------
Total number of life events checked off.
Moderate stress=! event High stress=2-3 events
Very high stress=more than 3 events
8
What is the most stressful life event you have experienced in the last year?
Daily hassles are the small daily stresses of everyday life that can add up if they occur over time. Examples of daily hassles include dealing with long bus rides, working with unpleasant or critical people, having conflicts with family members or close friends, living or working in a noisy chaotic place, and being rushed to do things.
The following checklist will help you evaluate how many daily hassles you are dealing with:
Daily Hassles Checklist
Place a check mark next to each event that you have experienced in the past week:
Tense relationships, especially when people around you are always arguing, angry, criticizing, or picking on you for nothing
Disrespected, teased, and treated as worthless
Too much to do and not enough time to do it
Nothing to do but sit around all day or deal with meaningless activities
Not enough money to take care of necessities
Not enough money to spend on leisure
Crowded living situation
Long drives or traffic back ups
Feeling rushed at home
Feeling rushed at work
Arguments at home
Arguments at work
Noisy situation at home
Noisy situation at work
Not enough privacy at home
Minor medical problems
Lack of order or cleanliness at home Lack of order or cleanliness at work
Unpleasant chores at home
Unpleasant chores at work
Living in a dangerous neighborhood Other: _
Total number of hassles in the past week
Moderate stress=1 or 2 daily hassles High stress=3-6 daily hassles
Very high stress=more than 6
9
What Are The Signs That Ycnlre Under Stress?
According to the stress-vulnerability model, stress is an important factor in causing disharmony within kanaka because it can worsen pilikia and lead to crises. If you can decrease stress, you can decrease symptoms. Therefore, being aware of your own personal signs of stress can be very helpful, because once you realize that you're under stress you can start to do something about it.
When people are under stress, it affects them physically and emotionally. It also affects their thinking, mood, and behavior. Some people show only physical signs of stress, such as muscular tension, headaches or sleep problems. Others have trouble concentrating or become irritable, anxious or depressed. Still others may pace or bite their nails. Each person's response to stress is individual.
You can use the following checklist to identify your own personal signs of being under stress. Put a check mark next to the signs you notice when you are under stress:
Signs of Stress Checklist
Headaches
Sweating
Increased heart rate
Back pain
Change in appetite
_ Difficulty falling asleep
Increased need for sleep
Trembling or shaking
Digestion problems Stomach aches
_ Dry mouth
Problems concentrating
Anger over relatively minor things Irritable
Anxious
Feeling restless or "keyed up" Tearful
_ Forgetful
Prone to accidents
Using alcohol or drugs (or wanting to) Other: _
Other:-------------
0ther: _
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How Can You Prevent Stress?
Putting energy into preventing stress can pay off. If you remove some stress in your life, you can enjoy yourself and to reach your goals. Below, choose the strategies that fit you:
Strategies for Preventing Stress Checklist
!Strategy | I | I already use this strategy | I would like to try this strategy or develop it further | |
Be aware of situations that caused stress in the past | I | |||
Practice aloha in my thoughts and my actions, forgiveness with myself and with others | ||||
Keep balance in my life - be' oluolu with all things and people as much as I can | ||||
Be kind to myself, honest in my criticism, and never mean to self or others | ||||
IExpress lokahi with my family and associates | ||||
I Schedule time for relaxation | ||||
I Schedule meaningful activities | ||||
I Take care of my health, eat well and exercise | ||||
I Talk about my feelings I | ||||
I Write down my feelings in a journal | ||||
Set reasonable expectations for myself - I don't demand too much or settle for too little | I | I | ||
Seek out people who are encouraging and supportive, rather than critical and pressuring | I | |||
I Take time out for myself | ||||
!other: |
Question: Which prevention strategies would be most helpful to you?
11
Hiu'wai
One day Kawika was feeling down. He kept fighting with his brother and didn't want to spend time with his ohana. Kawika had been hearing voices lately, telling him that he was no good. He knew he needed to go down to the beach like his mother would do. He wasn't sure how it would help, but it turns out doing the hiu'wai helped him feel calm and centered. He was ready to talk to his brother and make right. He also felt able to handle his stress.
Hiu'wai- The rituals of using the Ocean to cleanse, restore and purify Mana'o (mind), Kino (body) and Uhane (spirit).
Coping Effectively With Stress
Coping effectively with stress is a key to ola and pursuing your personal goals. Think about these questions:
How do you cope with stress?
What strengths would you like to try or develop further so that you can cope
with stress?
You can use the following checklist to record your answer to these questions
IWays to Cope with Stress | I | I already use this way | I would like to try this or develop it further | |||
ITalking to someone | I | I | ||||
I Using relaxation techniques [See appendix] | I | I I | I | |||
Using positive self talk. e.g. 'This is hare' but I can do it,' or Tf I take this one step at a time, I'll be able to handle it. ' | I | |||||
IMaintaining my sense of humor | I | I | ||||
Participating in religion or other form of spirituality | II | I | ||||
I Exercising | I | I | ||||
I Writing in a journal | I | I | I |
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I Listening to music or playing music I I | |
I Doing artwork or going to see artwork I | |
Participating in a hobby. e.g. hula, ukulele, paddling, finishing, quilting, gardening | I |
IGoing to the beach I I | |
I other: I II |
The Hawaiian Code of Conduct and the Four Agreements can help you think about ways to live a pono life. Some people use the Serenity Prayer and others, a document entitled, Desiderata. These works can help put you on the right path so that you are ready and able to cope with stress. They can both be found at the end of this book in attachments.
Think of ways to incorporate any one or all of those works into your life. If parts don't fit for you, toss them out for now. Take what you feel right with.
Which parts do you want to follow? 1.
2.
3.
4.
13
Develop an individual plan for coping with stress that works for you
This handout has checklists to help you identify the following: stressful situations, signs of stress, ways to prevent stress, and ways to cope with stress. It may be helpful to put this information together as a plan for coping with stress using the following form:
Individual Plan for Coping with Stress
Stressful situations to be aware of:
1.
2.
3.
Signs that I am under stress:
1.
2.
3.
Ways I prevent stress:
1.
2.
3.
Ways I cope with stress:
1.
2.
3.
14
Muscle relaxation
The goal of this technique is to gently stretch your muscles to reduce stiffness and tension. The exercises start at your head and work down to your feet. You can do these exercises while sitting in a chair.
Steps:
Neck rolls. Drop your head to one side. Gently roll it around in a wide circle. Repeat 3-5 times. Then reverse directions, and gently roll your head in a wide circle the other way. Repeat 3-5 times.
Shoulder shrugs. Lift both shoulders in a shrugging motion. Try to touch your ears with your shoulders. Let your shoulders drop down after each shrug. Repeat 3-5 times.
e Overhead arm stretches*. Raise both arms straight above your head. Interlace your fingers, like you're making a basket, with your palms facing down (towards the floor). Stretch your arms towards the ceiling. Then, keeping your fingers interlaced, rotate your palms to face upwards (towards the ceiling). Stretch towards the ceiling. Repeat 3-5 times.
0 Knee raises. Reach down and grab your right knee with one or both hands. Pull your knee up towards your chest (as close to your chest as is comfortable). Hold your knee there for a few seconds, before returning your foot to · he floor. Reach down and grab your left knee with one or both hands and bring it up towards your chest. Hold it there for a few seconds. Repeat the sequence 3-5 times.
Foot and ankle rolls. Lift your feet and stretch your legs out. Rotate your ankles and feet, 3-5times in one direction, then 3-5 times in the other direction.
*If it is not comfortable to do step #3 with your arms overhead, try it with your arms reaching out in front of you.
Imagining a peaceful scene
The goal of this technique is to "take yourself away" from stress and picture yourself in a more relaxed, calm situation.
Steps:
Choose a scene that you find peaceful, calm and restful. If you have trouble thinking of a scene, consider the following:
at the beach
on a walk in the woods
16
on a parkbench
on a mountain path
in a canoe or sailboat
in a meadow
next to a waterfall
paddling out to catch a wave
riding a bicycle
working the aina
After choosing a peaceful scene, imagine as many details as possible, using all your senses.
What does the scene look like? What are the colors? Is it light or dark? What shapes are in the scene? If it's a nature scene, what kinds of trees or flowers do you see? What animals?
What sounds are in your peaceful scene? Can you hear water or the sounds of waves? Are there sounds from animals or birds? From the breeze? From people?
What could you feel with your sense of touch? Are there textures? Is it cool or warm? Can you feel a breeze?
What smells are there in your peaceful scene?
Could you smell flowers? The smell of the ocean? The smell of food cooking?
Disregard any stressful thoughts and keep your attention on the peaceful scene.
Allow at least five minutes for this relaxation technique.
Lomilomi
Lomilomi is a style of Hawaiian massage in which the practitioner will work the tissue, muscles, and organs of the body. It can be very effective in bringing about relaxation as well as overcoming specific physical or psychological stress. Practitioners can easily be found in the community.
Chi Kung
Chinese developed a practice known as Chi Kung (the science of working with energy within the body; also spelled Qi Gong), which feature a blending of movement, breathing and meditation. Chi Kung practice focus on illness prevention and control through the balance of internal Chi. This stimulates the body's organs and systems into optimum efficiency. The result of practicing Chi Kung regularly is good health, a strong body, and a calm mind.
17
Yoga
Yoga is an ancient Hindu body of knowledge that dates back more than 5000 years ago. The word "Yoga" came from the Sanskrit word "yuj" which means "to unite or integrate." Yoga then is about the union of a person's own consciousness and the universal consciousness.
Ancient Yogis had a belief that in order for man to be in harmony with himself and his environment, he has to integrate the body, the mind, and the spirit. For these three to be integrated, emotion, action, and intelligence must be in balance. The Yogis formulated a way to achieve and maintain this balance and it is done through exercise, breathing, and Meditation - the three main Yoga structures.
In Yoga, the body is treated with care and respect for it is the primary instrument in man's work and growth. Yoga Exercises improve circulation, stimulate the abdominal organs, and put pressure on the glandular system of the body, which can generally result to better health.
Breathing techniques were developed based on the concept that breath is the source of life. In Yoga, students gain breathing control as they slowly increase their breathing. By focusing on their breathing, they prepare their minds for the next step - Meditation.
There is a general misconception that in Meditat ion·, your mind has to go blank. It
doesn't have to be so. In Meditation, students bring the activities of the mind into focus resulting in a 'quiet' mind. By designing physical poses and Breathing Techniques that develop awareness of our body, Yoga helps us focus and relieves us from our everyday stress.
rai Chi
T' ai Chi Ch'uan is often promoted and practiced as a martial arts therapy for the purposes of health and longevity. Traditional T' ai Chi training is intended to teach awareness of one's own balance and what affects it, awareness of the same in others, an appreciation of the practical value in one's ability to moderate extremes of behavior and attitude at both mental and physical levels, and how this applies to effective self defense principles. Some call it a form of moving meditation that has general health benefits and stress management.
T ' ai Chi Ch' Llan as physical training is characterized by its requirement for the use of leverage through the joints based on coordination in relaxation. The slow, repetitive work involved in that process is said to gently increase and open the internal circulation 18
(breath, body heat, blood, lymph, etc.). It allows a persons native energy to be available to them, which they may then apply more effectively to the rest of their lives; families, careers, spiritual or creative pursuits, hobbies, etc.
The study of T' ai Chi Ch'Uan involves three primary subjects:
Health - an unhealthy or otherwise uncomfortable person will find it difficult to meditate to a state of calmness or to use T' ai Chi as a martial art. T'ai Chi's health training therefore concentrates on relieving the physical effects of stress on the body and mind.
Meditation - the focus meditation and subsequent calmness cultivated by the meditative aspect of T' ai Chi is seen as necessary to maintain optimum health (in the sense of effectively maintaining stress relief or homeostasis) and in order to use it as a soft style martial art.
G Martial art - the ability to competently use T' ai Chi as a martial art is said to be proof that the health and meditation aspects are working according to the dictates of the theory of T' ai Chi Ch'Llan.
Hiu ' wai
The rituals of using the Ocean to cleanse, restore and purify Mana'o (mind), Kino (body) and Uhane (spirit). Many Seawater la'au soaks were used as a mean of healing and cleansing the mind, body and spiritual well-being of the individual, as well as addressing weight, skin disorders and promote a healing balance of health and wellness.
19
Why Is Building a Circle of Friends Important?
* A Cirde of Friends = An 'Upena of Supportive Relationships*
Human relationships are an important part of people's lives. Relationships can help reduce isolation.
The quality of one's relationship can play a major role in one's life. Friendships help people feel good and more optimistic about the future. Supportive relationships help people reduce stress.
Guiding Values for Building a Circle of Friends
LOKOMAIKA 'I: To Show Kindness and Goodness From Inside
[Acts of Kindness & Graciousness]
LAULIMA: MALAMA: A'O: PONO:
To Cooperate Willingly.
[Kokua & Volunteer to Help]
To Care for Each Other
[Mutual Help, Protect & Honor]
To Learn And to Teach
[Seek Knowledge & Share Experience] To Be Morally Fair in Judgment. [Righteous & Strive for Proper Behavior]
Question: Which of your relationships do you find supportive?
2
What Does Supportive Relationship Mean to You?
People have their own individual opinions about what makes a relationship supportive. They also have their own perspectives about what they want
from their relationships and whether they are satisfied with the number and quality
of their relationships.
Who are the people in your life that support you?
What kinds of things do people do that you find supportive?
Which aspects of your relationships are you satisfied with?
Which aspects of your relationships would you like to change?
In what ways are you supportive of other people?
Are you satisfied with the way that you are supportive of other people?
Would you like to have more social support in your life?
Question: Circle the number on the scale below which best describes how satisfied you are with your social support:
1 | 2 | 3 | 4 | 5 |
Not Satisfied | A Little Satisfied | Satisfied | Very Satisfied | Highly Satisfied |
3
Expanding and Strengthening Your Circle of Friends
@ You can expand your Circle of Friends by increasing the number of people with whom you have contact.
@' You can strengthen your Circle of Friends by improving the quality of your relationships with people with whom you have regular contact.
And always, remember the guiding values of LOKOMAIKA'I, LAULIMA, MALAMA, PONO & A'O when you build your Circle of Friends1
Here Are Some Specific Strategies for Connecting with People
A. Find places to meet people
Learn the tips for starting conversations
Learn the tips for developing doser relationships
4
A: Find Places to Me e t People
You can meet people in all kinds of places. Also, there are some places to go where meeting people may be easier. These tend to be public places where people naturally gather for recreation, to pursue an interest or to take care of business.
Have You Been To The Following Places To Meet People?
Places | I Have Gone To This Place To Meet People | I Would Like To Go To This Place In Order To Meet People | ||
Clubhouse (Hui Hana Pono) | ||||
Local Community College | ||||
Ohana Gatherings | ||||
Community Events | ||||
lsueeort Groues | I | |||
Church, Synagogue, Temple, Mosque, or other religious places | ||||
Workplace | ||||
Beaches | ||||
Health Or Exercise Club | ||||
!Parks I | ||||
Museums | ||||
IConcerts | ||||
5;: :: : Interest Groups | ||||
IRela}'. For Life Events I | ||||
!volunteer Programs I | ||||
!other: |
I
5
B: Tips for Starting Conversations
-1!J Timing and Opportunity is Always Important.
Use common sense. Don't interrupt if someone is engaged in activity and cannot or should not be interrupted. If a student is studying for a final exam, a surgeon in the middle of an operation, or a mechanic listening to the sound of an engine, you shouldn't interrupt to start a conversation.
-1!J Choose an Interesting Topic.
The topic you choose could be related to something that you are doing when you are starting the conversation. You could choose topics such as the weather, recent events, or sports. If you don't know the person, you can start by introducing yourself. But, as you do so, you should also be thinking of a topic to follow the introduction. The topic should be interesting and appropriate. For example, sexual intercourse would probably be interesting but certainly not appropriate, especially for an introductory discussion. War can be appropriate and interesting in some circles. Human rights or native Hawaiian rights are topics generally acceptable in Hawaii (but be willing to accept divergent view-points). Religion, as an initial introductory discussion may be too personal, unless the place is directly related to the religious topic.
How Direct And "In Your Face" Sh@uld You Get At The Beginning?
Remember that in Hawai' i, there are people of many different cultures. While eye contact may be stressed in a Western culture, it may not be appropriate in other cultures. Distance between a person you're speaking with and yourself may also be an important consideration. The rapidness in which you speak, the appropriateness of interrupting another's conversation for confirmation or support, and even the volume with which you carry on a conversation, should all be matters of sensitivity one should develop in meeting new people.
-1!J Sincerity Is Transparent - Don't Smile And Simply Nod Your Head To Pretend You Are Listening Or Understand What Is Being Said.
Listen to the conversation taking place. Try to understand what others may be saying. If you don't understand, don't be afraid to say so. Asking questions about what the other person says and responding to their comments lets them know that you are interested in their perspective. If the person seems uninterested, consider changing topics, politely end the conversation.
-1!J Be Selective When Telling Very Personal Things About Yourself.
When you are just getting to know someone, avoid telling the person very private
6
information about yourself. Such information too early in a conversation sometimes makes the person feel uncomfortable and can make it harder to make a connection.
Ways for Starting Conversations-Checklist
Strategy | I Already Do This | I Would Like To Try This Or Improve The Way I Do It |
IFind Someone Who Isn't Occupied | ||
!Choose An Interesting Topic | ||
(Examele: ) I | ||
ITry To Get "Tuned In" To The Person's Culture. | ||
!Don't Fake False Knowledge. | ||
!Tune In To What The Other Person Is Saying | ||
Be Selective In Telling Very Personal Things About Yourself | I | |
lather: | ||
lather: |
I
C: Tips for Developing Closer Relationships
There are f<>ur main considerations when you are developing a doser relationship:
Things you can say to the other person
Things you can do with the other person (or for the other person)
Deciding how much and when to disdose personal information about yourself
Adopting the Guiding Values for Building a Cirde of Friends
1: Things You Can Say to Develop Closer Relationships
Express Positive Feelings And Give Compliments
Telling other people how you feel about them can help bring you closer. This can include expressing and showing affection, but it is not limited to that.
7
Ask The Person Questions About Himself Or Herself.
Ask people about what they are thinking and feeling, try to understand their perspective, and show them you are interested in knowing more about them.
Tell The Person Something About Yourself.
Gradually telling people more things about yourself is part of becoming closer to them. You can tell people about your feelings, your opinions, things you like to do, and your past experiences. Deciding when and what to tell about yourself is discussed below in more detail.
Things You Can Say to Increase Closeness-Checklist
Types Of Things You Can Say | Specific Examples Of What You Could Say | How Comfortable Are You With This? |
Expressing Positive Feelings And Giving Compliments | I | |
Asking The Person Questions About Themselves | I | |
Telling The Person Something About Yourself | I | |
!other: | ||
!other: |
2: Things You Can Do To Develop Closer Relationships
Try To Understand The Other Person's Point-Of-View.
Each person's experience and perspective is unique. To understand someone's point of-view, it can be helpful to ask yourself questions such as
"What is the person feeling?" "What is the person thinking?"
"If I were in their shoes, what would I feel or think?"
Do Things Together.
Identifying activities ·that you can do together can provide rewarding experiences for both of you. Explore what interests you have in common in order to think of things you can do together.
Be Willing To Compromise.
In close relationships, neither person can always have their own way. Being willing to compromise and negotiate shows that you are not being selfish and that you care about him or her.
8
!ij/j Show By Your Actions That You Care About The Other Person.
Caring feelings can be expressed by actions as well as words. You can let people know that you care by being helpful, by surprising them in unexpected and pleasant ways, and by investing some of your time in trying to make them happy.
Be There For The Person And Help Out.
"Being there" for someone means being available during a time of need. Everyone has times of need. Recognizing when someone needs help and being able to support and assist him or her is an important sign that you care.
Types Of Things You Can Do | Specific Examples Of What You Could Do | How Comfortable Are You With This? | |
Try To Understand The Other Person's Point-Of-View | II I | ||
IDo Things Together | |||
IBe Willing To Comeromise | |||
Show By Your Actions That You Care About The Other Person | II I | ||
Be There For The Other Person And Help Out | |||
Other: | |||
lather: II II I |
Things You Can Do to Increase Closeness-Checklist
I
3: Ways You Can Disclose Personal Information To Develop Closer Relationships
"Disclosure" refers to telling someone personal information about yourself.
Deciding how much to tell someone can be a tricky decision. If you tell too much too soon, the other person may feel overwhelmed, and may pull away from the relationship. If you disclose too little, over time it may be difficult to have a really close relationship.
Keep in mind that when two people are close to each other, they tell each other about the same amount of personal information about "themselves. For example, if one person tells about their family background, the other person will usually follow by telling about the same amount about their own family background. You can start by matching the
9
other person's level of disclosure, and then gradually trying to increase -the level as you get to know each other better.
It can be helpful to identify three levels of disclosure: low, medium, and high. Low disclosure involves telling things about yourself that are not highly personal, such as your tastes or preferences for things like food, movies, television, or books. High disclosure is telling someone very personal information about yourself, such as having a mental illness. medium disclosure is somewhere in between.
Deciding what you want to disclose and what you want to keep to yourself is a personal decision based partly on whether you believe the other person will accept you after you have disclosed personal information.
Levels of Disclosure in Personal Relationships
Level Of Disclosure | Relationships You Have At This Level Of Disclosure | How Satisfied Are You With This Level Of Disclosure? |
Low Level Of Disclosure | I | I |
Medium Level Of Disclosure | I | I |
High Level Of Disclosure | I | I |
4. Always Remember:
The Guiding Values for Building a Circle of Friends
LOKOMAIKA 'I: Show Kindness And Goodness
LAULIMA:
MALAMA: A'O: PONO:
Kokuo. & Volunteer To Help
Care For Each Other To Learn And To Teach
Righteous & Strive For Proper Behavior
10
Hale Na'au Pono
Wai'anae Coast Community Mental Health Center, Inc. 86-226 Farrington Highway Wai'anae, Hawaii 96792
Telephone: (808) 696-4211 Fax: (808) 696-5516
Voyage to Recovery - Pathway 6
Using Medication Effectively
The patient is a chief; the kahuna is a chief
' Olelo No' eau 533
1
Ninau: What does this 'Olelo No'eau n1ean? How can I be a "chief' if I'm the guy who needs help? I need therapy, medication, or some other support. Why are we talking about a kahuna? Is 1ny case manager, clinician, or psychiatrist a kahuna? And how can this kahuna also be a chief, if I'm a chief?
Pane: This 'Olelo No' eau was explained by Kupuna Kawena Puku' i. She said this was the understanding a gatherer of la'au or 1nedicine would have as the gathering took place - not only is the expert or kahuna a chief in this process of healing, but the patient also has a role as a chief. In other words, both patient and healer are experts and carry authority in this healing process.
Ninau: Does this 1natter today any 1nore? Does this apply to 1ne and you, or is this just interesting historical or cultural information, good only for talking story?
Pane: Both. It applies to us today, because consu1ners as well as service providers have their own authority in the treatlnent that is given. The authority is not necessarily the saine, but everyone involved in the services have rights and responsibilities.
Ninau: Give 1ne some exainples?
Pane: A consumer has a lot of rights. First, is the right to receive and to refuse to be treated. Only in extre1ne cases, such as an i1n1ninent danger to self or to others, can a consu1ner be hospitalized against his or her will. A consu1ner can decide whether or not to take 1nedication or to engage in different programs. A consumer has the right to review the consu1ner' s records. There's a whole list of rights a consumer has which is posted at various parts of our facility, as well as reviewed by the consu1ner at the beginning of the treatment.
Ninau: What about responsibilities? Does a consu1ner have any?
Pane: Yes. One is the responsibility to be honest to the kahuna and to the treatment team when developing treat1nent or recovery plans. The second is to work in good faith in trying to carry out the plan. If the plan does not fit the
2
consumer any longer, the consumer has the responsibility to bring this matter to the attention of the team, generally through the case manager.
Ninau: What are the rights of the kahuna or "expert" who provides such treatment?
Pane: They all have different rights and responsibilities. A case manager, a clinician, a psychiatrist, a housing expert, an e1nployment expert, or any other person on a consumer's treat1nent tea1n has the right to be honest in his or her opinion of a treatment program, and if that team member can not work or put best efforts in the treatment prograin, has the responsibility to say so, explain why, and if necessary, seek to be replaced.
Ninau: Wow, I never saw it that way. I always felt I had nothing to say whenever a psychiatrist, or case manager laid out a plan or treatinent program. I guess knowing this, I also have to take 1nore responsibility in fashioning the right prograin for 1ny recovery!
H1n1n -- So, if I have rights as a chief, I also have responsibilities. I guess one of those would be to search n1yself about n1y own attitudes, 1ny willingness to undergo treatlnent, and taking a hand in designing 1ny plan so that I can recover.
Dialogue by Poka Laenui,
People have different beliefs about medication, based on their culture, their family background, and their own experience.
Let's find out what your personal beliefs are about medication...
3
Personal beliefs about medication
Some people have strong positive beliefs about medications. Make a check mark next to any of following quotations that reflect your beliefs:
"My uncle is diabetic and takes insulin. He leads a normal life. I have psychiatric pilikia and take medication for it. It's thesame thing to me."
"My medicine helps get rid of the pilikia I was having."
"I tried everything I could on my own, I was still feeling depressed until I tried
some medicine."
Other people have different beliefs about medications. Make a check mark next to any of the following quotations, which reflect your beliefs:
"I don't believe in Western medicines. I only want to use herbal remedies.""
"I don't need to use medicine at all. I believe pule (prayer) and 'oli (chant) are all
I need for getting rid of the pilikia I am having."
"I don't believe in taking medications, I only want to come to therapy."
---
"I'm afraid of the long-term effects on my body of using medications." "Some medication makes me feel like a zombie. I hate it."
"I don't need a drug to make me feel better."
Question: What do you think about medications?
Having strong feelings about medications may affect your decision about taking your medication. You may not ask enough questions about side effects or you might not find out enough about how the medicine could benefit you.
Understanding your personal beliefs about medication is only the first step in learning how to use medication effectively. You may also need to learn more about why medication is recommended as part of your recovery plan and the advantages and disadvantages of psychiatric medications.
4
Why is medication recommended as part of your recovery plan?
In handout "Pathway 2", you learned about the "stress-vulnerability model." This model is based on evidence that both biological vulnerability and stress contribute to psychiatric pilikia. Medications may reduce biological vulnerability by helping to correct the chemical imbalance in the brain.
When people take medications as part of their treatment. they usually:
Experience symptoms less often or less intensely. Concentrate better and think more clearly.
Fall asleep more easily and sleep more restfully. Accomplish more of their goals.
What are the potential benefits of medications for your psychiatric pilikia?
Medication has been found to be helpful in at least two important ways:
Reducing pilikia during a crisis
When the pilikia are the most severe and troublesome, it is usually described as being a relapse or a crisis. The experience of having relapses is different from person to person. Some individuals have only one or a few crises while others have them more often.
During and after a crisis, medications can help reduce the severity of the pilikia. Sometimes the medicine helps people rapidly, and they are able to relax, think more dearly, and feel less depressed in a few days. Other times it may take a few weeks before you feel better.
Reducing the likelihood of relapses
If you take your medications regularly, you may prevent future crises. One person described his medication as a "miracle for helping my symptoms." Taking medication is not a cure for all your pilikia, and there is no guarantee that you will not have relapse again. However, for most people, taking medication on a regular basis reduces their risk of relapses and hospitalizations.
Question: Have you had an experience where stopping your medication has been related to feeling worse or going into a crisis?
5
Which medications are used to improve psychiatric pilikia?
Different kinds of medications help different types of pilikia. There are several different types of psychiatric pilikia, and more than one medica·l·ion may be required to treat t hem.
There are four major categories of medications, which are commonly used to treat major mental illnesses. The medications and their benefits are summarized on the following char t :
Medications and Their Benefits
I Medication Category 11 Possible benefits I | ||||||||||
Antidepressants | Can reduce the pilikia of depression, including low mood, poor appetite, sleep problems, low energy and difficulty concentrating. They can also be effective in treating anxiety disorders. | |||||||||
Mood stabilizers | Can help depression | reduce | extremes | of | moods, | including | mania | and | ||
Antianxiety; Sedative medications | Can reduce anxiety, feeling over-stimulated, and difficulty sleeping |
Benefits from Medications I Have Used
Category of medication | Specific medication I used from this category | Benefits I experienced | |
Antidepressants I | |||
Mood St abilizer s I | |||
Antipsychotics I | |||
Antianxiety; Sedatives | II | ||
Other category: II |
6
What are the side effects of medication?
Medication affects people in different ways. Some people may have only a few side effects or no side effects at all from their medication. Others taking the same medication may have significant side effects. Your reaction to medication depends on many factors, including your age, weight, sex, metabolic rate, and other medicines you might be taking.
In most cases, the side effects are temporary, and improve over time as your body adjusts to the medication. Some types of side effects, which are much less common, can be long lasting and even permanent. The newer medications tend to have fewer and less severe side effects. The more serious side effects are associated with the older antipsychotic medications, such as haldol, stelazine and thorazine.
If you recognize that you are having side ef f ect s, it is important to contact your doctor as soon as possible. Your doctor needs to help you evaluate how serious the side effects are and what can be done about t hem. It is up to you to decide what side effects you can tolerate and what risks you are willing to accept .
When you have side effects, your doctor may advise you to try one of the following: reduce the dose of the medication, add another medication for the side effect, or switch to another medication.
What side effects from medication have you experienced?
Caf'egor.y of medication | I I | Specific medication I used from this category | Side effects I had when taking this medication | |
Antipsychotics [appendix 1] | I | |||
Mood stabilizers [appendix 2] | ||||
Ant idepr essants [appendix 3] | ||||
Antianxiety & Sedatives [appendix 4] | I I | I | ||
I o t her: I |
7
Coping with side effects
I Side effect IIstrategy I | |
Drowsiness | Schedule a brief nap during the day. Get some mild, outdoor exercise, such as walking. Ask your doctor about taking medication in the evening |
Increased appetite and weight gain | Emphasize heal-thy foods in your diet, such as fruits, vegetables and grains. Cut down on sodas, desserts and fast f oods. Engage in regular exercise. Go on a diet with a -friend or join a weight reduction program. |
Extreme restlessness | Find a vigorous activity that you enjoy, such as jogging, skat ing, aerobics, sports, outdoor gardening, swimming, bicycling |
Muscle stiffness | Try doing regular muscle stretching exercises or yoga or isometrics exercises |
I Dizziness II Avoid getting up quickly from a sitting or lying down position. I | |
Blurry vision | For mild blurry vision, talk to your doctor about getting reading glasses. These can often be bought without a prescription at a local drug store for very little money. |
Sensitivity to the sun | Stay in the shade, use sunscreen and wear protective clothing. Avoid going out at the sunniest time of day. |
Shakiness or tremors | Avoid filling cups and glasses to the brim. |
Dry mouth I C_hew sugarless gum, suck on sugarless hard candy, or take frequent sips of water. | |
Constipation | Drink 6-8 glasses of water daily. Eat high fiber foods such as bran cereals, whole grain breads, fruits and vegetables. Do light exercise daily. |
Iother: I | I |
Iother: I I |
The following charts list some of the common side effects of different categories of medications and some suggestions for coping with them or counteracting them.
I
8
If you decide to take medications, how can you get the best results?
Many people find that it can be difficult to remember to take medications regularly. "Behavioral tailoring" consists of the following strategies, which are designed to help you to fit taking medications into your regular routine. Since everyone has a different routine, it is important to tailor these strategies to meet your own needs.
Simplify your medication schedule as much as possible.
When you take several medications several times each day, it becomes difficult to keep track of all the doses. Talk to your doctor about making your medication schedule as simple as possible without losing any of the benefits. The fewer the medications you have to take and the fewer the number of times per day, the easier it is to keep track. Some medications are available in long-acting injectible forms that can be administered every two weeks.
Take medications at the same time every day.
Taking the medication at the same time (or times) every day ma es it easier to remember. It also keeps the level of medication at a steady level in your bloodstream, which gives you maximum benefit throughout the day.
Build taking medication into your daily routine.
It is often easier to remember to take medication if it is done in conjunction with another daily activity. Examples of daily activities include brushing your teeth, showering, eating breakfast, and getting ready to go to work.
Use cues to help yourself remember.
Some examples of cues include: using a pill container that is organized into daily doses, using a calendar, making notes to yourself, keeping the pill bottle next to an item that is used daily, asking a relative or other supporter to help you remember.
Keep the benefits in mind.
Sometimes it helps to remind yourself of the reasons that you have decided to take medications.
9
Strategies for Getting the Best Results from Medication
Strategy . | I have used this strategy | I would like try develop it further | this | strategy | or | ||||
Simplify the medication schedule | I | ||||||||
Take medications at the same time every day | II | I | |||||||
Build taking medication into my daily routine | II | I | |||||||
Use cues and reminders (calendars, notes, pill organizers) | I | I | |||||||
Remind myself of the benefits I of taking medications | |||||||||
I other: | II | I | I |
I
How do you make an informed decision about medication?
You need to make informed decisions about all treatment options in your recovery plan, including medication. In making your decision about medications, it is important to learn as much as you can and to weigh the possible benefits and possible drawbacks of taking medication.
We. 1gh the pot ent·1aI benet·It s and drawbackso ft
aki.ng your me 1ca ions:
Potential Benefits of taking medications | Potential drawbacks of taking medications |
10
Your psychiatrist is an expert about Western medications and has experience helping others find effective medications. However, it is also important for you to be very active in making decisions about medication. After all, you are the expert about your own experience of pilikia and what makes you feel better or worse. Therefore, the best method for making a decision involves a partnership between you and your doctor, using both of your expertise together.
It helps to have some questions in mind when you are deciding about taking medication or switching medications. ,,,
\ 'qt1 j
t ,-1,:' 1-".'\},) .
( ):::;\
i,/1 0' I
Questions You Can Ask Your Doctor J-- 7/ \
How will this medication benefit me? What will it help me with?
, How long does it take the medication to work? How long before I feel some of the benefits?
What side effects might I get from the medicine? Are there any side effects from long-term use?
What can be done if I get side effects?
Will I need blood tests to make sure that I have the right level of the medication in my bloodstream?
What if the medication doesn't work for me?
Remember:
Medications for psychiatric pilikia usually take time to work. It may take several weeks before you notice a difference in the way you feel. Also, everyone responds to medication in different ways. It can take time for you and your doctor to find the medication that helps you the most and has the fewest side effects. So, talk to your doctor on a regular basis about how you are feeling, so that you can work together to find the best medicine for you.
PAU
11
Appendix 1 : Antipsychotic medications
Antipsychotic medications are sometimes called "major tranquilizers" or "neuroleptics." They are designed to reduce the pilikia of psychosis, including false perceptions (hallucinations), false beliefs (delusions), and confused thinking (thought disorders). They not only help reduce psychotic pilikia during and after a crisis, but also help prevent relapses and rehospitalizations. They are not addictive. Some of the newer medications also help reduce other pilikia, including lack of energy, motivation, pleasure, and emotional expressiveness.
Two types of antipsychotic medications are available. The older generation antipsychotics include haldol, moban, mellaril, navane, prolixin, serentil, stelazine, thorazine and trilafon. The newer generation antipsychotics include clozaril, geodon, risperdal, seroquel, zeldox, and zyprexa.
The following chart contains the brand names and chemical names of the antipsychotic medications currently available. [*newer generation antipsychotics]
Brand name 1 1 Chemical name I |
Clozaril* 11 Clozapine I |
Haldol I Haloperidol I |
Loxitane Loxapine I |
Mellaril Thioridazine |
Moban Molindone |
Navone Thiothixene |
Prolixin Fluphenazine |
Risperdal* Risperidone |
Serentil Mesoridazine |
Seroquel* Quetiapine |
Stelazine Trifluoperazine |
Thorazine Chlorpromazine |
Trilafon Perphenazine |
Geodon* Ziprasidone |
Zyprexa* Olanzapine |
More medications are being developed all the time, so it is important to keep up-to-date with your doctor about what medications are available.
12
Side effects of antipsychotic medications
People have very different reactions to medications. Some people who take antipsychotic medications experience only a few side effects or none at all. Others experience several. It's also important to keep in mind that each medication has its own side effects, so you need to talk to your doctor about the specific side effects that are associated with the medication that has been recommended to you.
The main advantage of the newer generation medications is that they cause very few of the extrapyramidal (muscle movement) side effects that the older generation medications caused, such as muscle stiffness, mild tremors, restlessness, and muscle spasms. They also cause signi-ficantly fewer problems related to sexual difficulties and irregular menstrual periods. However, both the older and newer antipsychotic medications can cause weight gain, and some of the newer ones do so even more.
Tardive dyskinesia is an undesirable neurological side effect. It causes abnormal muscle movements, primarily in the face, mouth, tongue and hands. Tardive dyskinesia is associated with long-term use of the older antipsychotic medications and ranges from mild to sever e. It is important to let your doctor know if you notice any abnormal muscle movements, so that he or she can evaluate for tardive dyskinesia.
Some side effects of antipsychotic medications are rare, but can be very serious if they occur. "Agranulocytosis" is when people stop making the white blood cells needed to fight infections. It is a potentially dangerous side effect of clozaril. However, when regular blood tests are done to monitor white blood cell levels, clozaril can be a very safe medication.
Treatment of Side Effects
When you have side effects, contact your doctor immediately. After discussing the side effects and evaluating how serious -they are, he or she may recommend one of the following: reduce the dose of the medication, add a side effect medication, or switch to another medication. The doctor may also suggest some things that you can do to help reduce the discomfort or counteract the side effects. See Appendix #5 for a list of some of these coping strategies.
Web sites for more information about medications
www.mentalhealth.com www.mentalhealth.about .com
13
Appendix 2: Mood stabilizers
Mood stabilizing medications help treat problems with extremes of moods, including mania and depression. They help to reduce the acute pilikias and also help to prevent relapses and rehospitalizations. They are not addictive.
The following chart lists the most common medications in this category.
Mood Stabilizing Medications
Brand Name Chemical Name | |
Eskalith, Eskalith controlled release Lithium carbonate | |
Tegretol carbamazepine | |
=============== Depakote, Depakene valproic acid |
Side effects of mood stabl'lizers
Not everyone who takes mood stabilizers experiences side effects. However, it is important to be aware of possible side effects and to contact your doctor as soon as you notice them.
lithium
Possible side effects of lithium include nausea, stomach cramps, thirst, fatigue, headache, and mild tremors. More serious side effects include: vomiting, diarrhea, extreme thirst, muscle twitching, slurred speech, confusion, dizziness, or stupor. Although lithium is a natural chemical element, like oxygen or iron, it can be harmful if it is taken in too high a dose. To prevent this, the doctor must monitor the amount of lithium in the body by taking regular blood tests.
It is also important to have enough salt in your diet while taking lithium, because the sodium in salt helps to excrete lithium. This means you should avoid low-salt diets and prescription and over-the-counter diuretic medications such as Fluidex with Pamabrom, Aqua-Ban, Tri-Aqua, or Aqua-rid.
Tegretol and Depakote
Possible side effects of Tegretol and Depakote include: fatigue, muscle aching or weakness, dry mouth, constipation or diarrhea, loss of appetite, nausea, skin rash, headache, dizziness, decreased sexual interest, and temporary hair loss.
14
Some side effects are more serious, including: confusion, fever, jaundice, abnormal bruising or bleeding, swelling of lymph glands, vomiting, and vision problems (such as double vision). It is important to have regular blood tests to monitor the level of these medications, and to check for any changes in blood cells and liver function. Because these medications can cause sedation, you must be cautious when driving or operating heavy machinery. It is recommended to limit drinking to one alcoholic drink per week.
Treatment for side effects
When you have side effects, contact your doctor immediately. After discussing the side effects and evaluating how serious they are, he or she may recommend one of the following: reduce the dose of the medication, add a side effect medication, or switch to another medication. The doctor may also suggest some things that you can do to help reduce the discomfort or counteract the side effects. See Appendix #5 for a list of some of these coping st r at egies.
Web sites for more information about medications
www.m entalhealt h.about .com
15
Appendix 3: Antidepressants
Antidepressants treat the pilikias of depression, including low mood, low energy, appetite problems, sleep problems, and poor concentration. They help to reduce the acute pilikias and prevent relapses and hospitalizations. Antidepressants can also be effective for the treatment of anxiety disorders such as panic disorder, obsessive/compulsive disorder and phobias. They are not addictive.
The newer generation antipsychotic medications, such as the family of drugs called serotonin selective reuptake inhibitors (SSRis) tend to cause fewer side effects. SSRis include Prozac, Paxil, Zoloft, Serzone, and Luvox. New medications continue to be developed. The following chart lists the most common antidepressants. [* newer generation antidepressants (SSRis)]
Brand Name | il c nemical Name | I | ||||||
Anafranil | Clomipramine | |||||||
Desyr el. | Trazodone | |||||||
Effexor | Venlafaxine | |||||||
Elavil | Ami-triptyline | |||||||
Ludiomil | Maptrotiline | |||||||
Luvox* | Fluvoxamine | |||||||
Marplan | - | Isocarboxazi d | ||||||
. Nardil | .. | . | . | Phenelzine | ||||
Norpramin | Desipramine | I | ||||||
Pamelor, Aventyl | Nortriptyline | |||||||
Paxil* | Paraxitine | |||||||
Prozac* | Fluoxetine | |||||||
Sinequan, Adapin | Doxepin | |||||||
Tofranil | Imipramine | |||||||
Vivactil | II Protriptyline | |||||||
Wellbutrin | 1 | 1 Buproprion | ||||||
Zoloft* | i l s er t r aline |
16
Side effects of antidepressants
Not everyone has side effects when they take antidepressants. But it is important to be aware of them in case you do. Tell your doctor about any of the following side effects: nausea, vomiting, excitement, agitation, headache, sexual problems, dry mouth, dizziness, sedation, weight gain, constipation, heart palpitations, cardiac abnormalities, insomnia, memory problems, overstimulation, hypertensive crisis.
Hypomania, mania and antidepressants
Sometimes a small percentage of people who take antidepressants develop pilikias of hypomania or mania over the course of a few weeks. The pilikias of hypomania include irritability, argumentativeness, agitation, decreased need for sleep, and excessive talking. The pilikias of mania include grandiosity, euphoria, hostility, extreme goal-directed behavior, and engagement in activities that are potentially harmful. If you experience these pilikias, notify your doctor immediately. He or she may lower your dosage of medication or stop it alt oget her.
Precautions when taking Marplan and Nardi/
There are many foods and drugs that should be avoided when taking Marplan and Nardil, including foods that are high in tyramine, such as aged cheeses, aged meats such as salami and pepperoni, and yeast extracts (except when they are baked into breads, etc). You should also avoid drinking beer, Chianti wine, sherry wine and vermouth and taking certain medications such as Tegretol, Dopar, Sinemet, Demerol, Aldomet, Ritalin,
.decongestants and_ st imulant s. It is important to obtain a complete list from yoL1r doctor of drugs and foods to avoi_d.
Although it is unusual, occasionally people develop carpal tunnel syndrome when they take Marplan or Nardil. This can be corrected by appropriate vitamin supplements.
Treatment of side effects
When you have side effects, contact your doctor immediately. After discussing the side effects and evaluating how serious they are, he or she may recommend one of the following: reduce the dose of the medication, add a side effect medication, or switch to another medication. The doctor may also suggest some things that you can do to help reduce the discomfort or counteract the side effects. See Appendix #5 for a list of some of these coping strategies.
17
Appendix 4: Antianxiety and sedative medications
Antianxiety and sedative medications help reduce anxiety and feeling overly stimulated. Some of these medications also help people sleep.
Unlike other medications for mental illnesses, these medications take only one to two hours to take ef f ect .
Also unlike other medications for mental illnesses, some antianxiety and sedative medications can be addictive and long-termuse should generally be avoided. If these medications are used, they should be carefully monitored.
The following chart lists the most common medications used for antianxiety and sedation. It is important to note that some of the medications can be used to help both anxiety and sleep problems, while others are used to help only one of these problems. Also, some of these medications are addictive, while others are not. It is important to talk to your doctor about the specific benefits and side effects of the medication you are taking.
Antianxiety and Sedative 1M edicat ions
Brand I\Jame Chemical Name I |
Ativan j lorazepam I |
Benadryl diphenhydramine I |
Buspar buspirone |
Centrex prazepam |
Dalmane flurazepam |
Halcion triazolam |
Klonopin clonazepam |
Librium chlordiazepoxide |
Noctec Chloral hydrate I |
Restoril temazepam I |
Serax ] oxazepam I |
Valium I diazepam I |
Xanax I alprazolam I |
18
Side effects of antianxiety and sedative medications
Not everyone has side effects when they take antianxiety or sedative medications. It's important to be aware of them if you do, however, and to talk to your doctor right away. The most common side effects are over-sedation, fatigue, and problems with memory or other cognitive abilities. Because of the sedating effect, you are advised to limit drinking no more than one alcoholic drink per week. You are also advised to be cautious when driving. As mentioned earlier, long-term use of some of these medications can lead to dependency.
Treatment of side effects
When you have side effects, contact your doctor immediately. After discussing the side effects and evaluating how serious they are, he or she may recommend one of the following: reduce the dose of the medication, add a side effect medication, or switch to another medication. The doctor may also suggest some things that you can do to help reduce the discomfort or counteract the side effects. See Appendix #5 for a list of some of these coping strategies.
Web sites for more information about medications
www.mentalhealth.com www.mentalhealt h.about .com
19
Hale Na'au Pono
Wai'anae Coast Community Mental Health Center, Inc. 86-226 Farrington Highway Wai'anae, Hawaii 96792
Telephone: (808) 696-4211 Fax: (808) 696-5516
Vo e to Recover Pathway 7
The Effects of Drug and Alcohol Use
We need to be just and seek harmony in all that we do. Pono teaches the attitude of positivism and optimism. When you are "Po no11 you wm have the feeling of contentn1ent and harmony. Pono is a natural high with only positive effects on others. Life itself excites you.
Alcohol and street drugs can give you a temporary and false high. Such substances can also cause pilikia, which hits not only the user but loved ones and others around you. Such substances make it more difficult for people to get back to rightness & balance.
In this pathway, we'll talk about the effects of drug and alcohol use on your health, why people use these substances and the ways to develop a sober life-style with the help of some important Hawaiian values that will help you achieve pono and wellness.
1
Why People Use Alcohol and Drugs
PEOPLE USE DRUGS AND ALCOHOL FOR A NUMBER OF RE ASONS: 1: TO SOCIALIZE
It's what people do when they get together, sharing their alcohol or drugs in social gathering. Some folks may drink or use drugs to be accepted, to keep those friends or lovers who are using, or to avoid loneliness. Alcohol and other substances are sometimes used to celebrate certain occasions, such as a holiday, a special occasion, or even a payday.
2: BECAUSE IT FEELS GOOD
For some people, use of alcohol or drugs is simply because it makes them feel good temporarily. Some people find that using substances makes them feel more alert and energetic, tranquil and satisfied, happy and carefree. For some people drugs and alcohol alter their perceptions of the world around them.
3: TO COPE WITH BAD FEELINGS OR PILIKIA
People will turn to alcohol or drugs when there is a disharmony within themselves or their relationships with others. That disharmony may be caused by stress, psychological or emotional imbalance, or other pilikia. People use alcohol and drugs to cope with the bad feelings or troubling pilikia. Substances may be used to deal with feelings of depression or anxiety. Or people may use substances to escape from hearing voices or other hallucinations. For some people, using substances may help them get to sleep. Others may use substances because it helps them focus their attention.
4: TO DI STRACT THEMSELVES FROM PROBLEM SITUATIONS
People may also use substances as a way of distracting themselves from problem situations or unpleasant parts of their lives. For example, some people may use alcohol or drugs to distract themselves when they are having conflict with others, when they are under high stress, when they are dissatisfied with parts of their lives (such as not working, not having a nice place to live, or not having good friends), or when they are unhappy with themselves.
5: TO HAVE SOMETHING TO DO
One reason some people use substances is that it becomes part of their daily routine, and gives them something to look forward to. For these individuals, using alcohol or drugs is more than just a habit; it is part of their lifestyle and an important part of how they live each day.
2
Question: From your own observations, what do you think are the most common reasons that people use substances?
Common pilikia related to drug and alcohol use
Using substances can also have negative effects and can interfere with having a healthy and pono life. Understanding both the positive and negative effects of using substances can help in deciding whether to change this habit.
S©me of the conwnon pilik ia related to drug and ak ohol use are described
below:
1 : I ncreas in g psychiatric pilikia and cr ises :
The effects of using substances on pilikia are partly due to people with psychiatric pilikia are supersensitive to the effects of substances. Using substances can
Bring on new pilikia Worsen existing pilikia
Lead to crisis and hospitalizations
2: Using subst ances can cause pilikia with other people:
Ku' e' e (disagreement) about use of substances, arguments with ohana o Loss of trust
Loss of children
Abuse of family
Failure to meet responsibilities leading to loss of home, bringing about homelessness
Become less predictable and harder to get along with
"I was all cut. My maddah started yelling at me and I just lost it ..."
Become easily irritated, easily angered, explosive
Become unable to perform duties because of substances use, such as not being a good Makua (parent), spouse, or worker
Hanging out with the wrong types of people and may increase the chances of being arrested due to one's illegal behavior
"We were just smokin' a joint, and Paul's friend rolled up in his car. I neva know was stolen, and that had 2 pounds of dope in the back. We went cruzing in his car and the cops busted us, all of us! Now we all facing a drug r ap."
Can increase the chances of being evicted from housing
"Some guys came over with a small stash, so we sat in the parlor, mindin our own business, enjoying some weed, when the landlord passed my door, caught us smoking. In 24 hours, I was living on the beach, without even a tent, and all my stuff that nevah get stolen was soaked and ruined."
3
"In my case, I came home stoned. My maddah said 'wait on the porch for awhile.' She packed up all my clothes, threw um out the front door, and said, 'you no mo house hea, go live whea you wen get stoned."
Increase susceptibility to being sexually or financially abused
"I thought we were just a bunch of friends getting stoned together. After I was gang-raped, I contracted Hepatitis. The guys who did it just snicker and play like it was all a big joke. They don't know that payback day is still to come."
"I had $55,000 for my work injury one year ago. Suddenly, lots of friends came around. We smoked, drank, and did some hard stuff. I loan some money to the guys. Today, I got exactly $87 in the bank, no job, no wife (she took the boy and moved out), nobody comes around, and nobody remembers the money I lent them! They tell me I'm hallucinating."
3: Usii,ig substances can interference with work or school:
Difficulty focusing at work and doing job well
"Downing" or "Coming down"
May be late or have absences from work due to using substances the night before
"I had a terrific job, everybody liked and respected me, treated me well. One day, we got a surprise - drug test! They found I had used cocaine and ice. I got suspended for two weeks, and in that time had to enroll in drug counse li ng. I had no insurance to pay for counseling, eventually lost my job, and never worked since then."
Make it hard to focus on schoolwork and lead eventually to dropping out
"I was going for a Bachelor's degree, was attending all my classes, had a lot of friends, sitting on top of the world. I was too confident, thought I could control the drugs and succeed in school. I let things get out of hand - fooled myself into thinking I could finish my study assignments, write all my papers, and continue to attend classes. Instead, all I started to do was make excuses, depend on classmates for their notes, and try to get my instructors to give me extensions, or special assignments for those I missed. Eventually, I flunked out. I wonder if I'll ever get that degree now."
4: Poor self-co.re
- May not shower, brush teeth, or keep up appearance
.WJ Do not eat well when using substances
Do not take adequate care of their living space, e.g. dirty and hazardous living conditions
o "I graduated w/ Phil. He was a real popular guy, at the top of his class, great athlete. I thought he was going to be a real big success. But after high school, he gradually moved to hard drugs. Today, his teeth are all rotten, he stinks,
4
doesn't shower, and the house he lives in is like a pig-pen. The sad part is that he doesn't care about anything but getting the next high. His health and life is ruined."
5: legal pilikia:
Driving under the influence of alcohol or drugs is against the law and can result in severe penalties.
People can also be jailed for possessing illegal drugs.
Parents with substance use problems have their children taken away from them, or may face restrictions on their ability to see or parent their children.
Using disability money, such as SSI or SSDI, on drugs or alcohol can lead to restrictions on access to that money, and the need to have a representative payee (or some other legal representative) manage one's money.
Leads to other criminal offenses.
6: Health piiikia:
The use of cocaine, heroin, and amphetamines are linked to infectious diseases such as hepatitis C and the HIV virus. These are blood-borne diseases that can be spread through exposure to an infected person's blood, such as by sharing needles
Long-term alcohol use can produce liver problems such as cirrhosis
Neglect to take care of chronic health conditions such as diabetes and high blood pressure
Because of the physical effects of using substances and the neglect of one's health, substance use can shorten one's lifespan
Prone to accidents, false sense of security and power, lack of inhibition (no hilahila), loss of common sense.
PEOPLE WITH PSYCHIATRIC PILIKIA ARE SUPER SENSITIVE TO THE EFFECTS OF ALCOHOL AND DRUGS
People with a mental illness are more sensitive to the effects of drugs and alcohol than people who do not have psychiatric pilikia. It takes lower amounts of substances to have effects on people with psychiatric pilikia. In fact, it can be said that having psychiatric pilikia make some people super-sensitive to the effects of drugs and alcohol.
Do you have a problem with alcohol and other drugs use?
Is alcohol and drug use causing pilikia in your life?
Circle a number below that indicates where you're at from"0 "for having no pilikia with alcohol and drugs use to" 0 "having many serious pilikia related to alcohol and drug use.
5
+ 0 --- 0 --- 8 --- 0 --- 0 --- 0 --- 0 --- & --- @ --- 0
No pilikia --------------------------- Have some pilikia Have many serious pilikia
Use the following checklist to find out.
Check the following statements that describe you:
-. _ I frequently (once or twice a day) find that my conversation centers on drug or drinking experiences.
I drink or get high to deal with tension or physical stress.
Most of my friends or acquaintances are people I drink or get high with.
I have lost days of school/work because of drinking or other drug use.
I have had the shakes when going without drinking or using drugs.
I regularly get high or take a drink upon awakening, before eating, or while at school/work.
I have been arrested for Driving Under the Influence of a substance.
I have periods of time that can't be remembered (blackouts).
Family members think drinking or other drug use is a problem for me.
I have tried to quit using substances but cannot. (A good test is voluntarily going for six weeks without substances and not experiencing physical or emotional distress.)
I often double up and/or gulp drinks or regularly use more drugs than others at parties.
I often drink or take drugs to "get ready" for a social occasion.
I regularly hide alcohol/drugs from those close to me so that they will not know how much I am using.
_ I often drink or get high by myself.
My drinking or use of drugs has led to conflict with my friends or family members.
In general, the more items noted, the more likely that you may have a problem with using substances. If you noted 3 or 4 of the statements you should be concerned about the way you use substances. If you noted more than 4, it would probably be a good idea to talk about your use of substances with your case manager or other health workers.
Weighing the Pros and Cons of Using Substances
To best underst and your own pros and cons for using subst ances, comp let e Wor ksheet 1 below. A nd, to find out more about t he commonly used substances and t heir ef f ect s, please see App endix 1 of this handout .
6
system, housing, or
legal
health,
money ...
work/school problems, problems with
friends,
and
Ohana
with
More pilikia or crises,
Such as:
trouble
"CONS" -- Write down all the bad
things about using drugs and alcohol.
"PROS" -- Write down all the good things about using drugs and alcohol. Consider advantages such as: socializing, feeling good, escaping, coping with pilikia, something to look forward to, habit...
WORKSHEET 1 : Pros and Cons of Using Substances
Considering all the "pros" and "cons" of using substances, would you like to cut down/stop?
NO. I do not want to cut down or stop.
MAYBE.I think I might want to cut down or stop but I'm not sure.
YES.I would like to cut down or stop.
(+) Write down below all the advantages of continuing to use drugs and alcohol. Consider advantages such as: socializing, feeling good, escaping, coping with pilikia, something to look forward to, habit, and any others that might be important.
ANSWER: The good things about using substances are
(-) Write down below all the disadvantages you can think of for using substances. Consider disadvantages such as: worse pilikia or relapse of mental illness, conflict with family or friends, trouble with work or school, parenting difficulties, problems with healt h, legal system, housing, or money.
7
ANSWER: The bad things about using substances are
Deciding Whether to Cut Down or Stop Using Substances
Understanding t he "pros" and "cons" of using substances can help you decide whether you want to cont inue using. It is also helpf ul to consider the "pr os" and "cons" of not using substances. What are the advantages of devel oping a sober lif est yle? What would you have to give up in or d er to develop such a sober lifestyle? Complete Worksheet 2 below.
WORKSHEET 2:Pros and Cons of Sobriety
"PROS" -- Consider how sobriety may help you achieve personal recovery goals, such as better control of your pilikia, better relationships, more independence, better health, ability to work and go to school, better parenting, fewer legal, housing, money, or health pr obl ems.
"CONS" -- What are the disadvantages of becoming sober? Write down below what you think you might have to give up if you stop using substances. Consider the "costs" of sobriety, such as losing friends, nothing fun to do, troubling pilikia, no escape, and feeling bad.
8
Considering all the "pros" and "cons" of sobriety and the "pros" and "cons" of using substances. Would you like to cut down/stop? Check your answer.
NO. I do not want to cut down or stop.
MAYBE. I think I might want to cut down or stop but I'm not sure.
YES. I would like to cut down or stop.
Stop Using Altogether or Cutting Down?
Deciding to take control over one's life by addressing pilikia related to drug or alcohol use is an important decision. It involves changing ones lifestyle. Part of making such a decision involves deciding whether you want to stop using substances altogether (abstinence) or whether you prefer to cut down but not stop using entirely.
People with substance use problems often find it difficult to successfully cut down on using substances, because using even a small amount makes them want to have more. A common problem is that people sincerely intend to drink a small amount of alcohol or take a small amount of drugs, but end up drinking or using a lot more. For this reason, many people with drug and alcohol problems find it easier to develop an abstinent lifestyle rather than to cut down on the amount they use.
Some people want to make changes to address their substance use problems, but are not ready to stop using drugs or alcohol completely. For people who do not choose abstinence as a personal goal, reducing the amount of alcohol or drugs that they use can be helpful.
Sometimes people begin with the intention of cutting down their use of alcohol or drugs, and then find it easier to become abstinent.
Question: Have you (or someone you know) tried to cut down substance use in the past? What happened?
Enhancing Your Lifestyle
When people decide to develop a sober lifestyle, it takes planning and practice. Sometimes there can be setbacks along the way, such as urges to use substances or relapses in substance use. Developing your own personal plan for a sober lifestyle is an important part of managing your pilikia and achieving your personal recovery goals. There are four important steps to achieving sobriety:
9
Embrace the traditional Hawaiian beliefs and values that help you achieve PONO.
Remember your reasons for not using substances.
Develop a pkm to prevent going back to using substances in "high risk" situations.
Identify new ways of getting your needs met.
You may want to use WORKSHEET 3 below to help develop your Sobriety Action Plan.
WORKSHEET 3: Action Plan
Complete this Action Plan by following the steps outlined below. You can change or modify your plan based on how well it is working for you. Share your plan with people who are close to you so they can support you in achieving your goals.
Step 1:
Taking control over your life and tackling your substance use problems can be hard work, and there may be setbacks along the way. However, your strength and determination will pay off as you become sober and reclaim your life.
Guiding Values for Achieving your Goals
Hana pono: We need to do good, and be accountable for our actions.
'Onipaa: We need to remain steadfast and resolute and persevere to overcome adversity.
Imi °Ike: We need to seek knowledge and enlightenment.
00 ia 'lo: We need to be truthful.
Haahaa: We need to be humble.
Laulima e kokua: We need to work together and help one another.
10
Malama: We need to care for one another.
Pono: We need to be just and seek harmony in all that we do.
Step 2: List one to three reasons how your life will be better by cutting down or stopping using substances. Consider how your action plan may help you achieve your personal recovery goals.
1.
2.
3.
Step 3: Make a plan for how to deal with "high risk" substance use situations. Consider situations in which you have used substances in the past, such as people offering you substances, being pressured to use, feeling bad, having nothing to do, and cravings. For each situation, identify one or two ways of dealing with it. Effective strategies for dealing with these situations may include: avoiding the situation, learning how to say "no" when the situation cannot be avoided, and dealing with urges to use in situations not involving other people.
Situation 1:
Plan for dealing with it:
Situation 2:
Plan for dealing with it:
Situation 3:
Plan for dealing with it:
11
Step 4: Find new ways of getting your needs met. Consider some of the reasons you have used substances, such as hanging out with friends, feeling relaxed or "high," dealing with pilikia, or having something to do. Choose some reasons why you have used substances in the past, and for each reason identify at least one new strategy for getting your need met.
Need 1:
New Strategy:
Need 2:
New Strategy:
Need 3:
New Stra tegy:
The dawning of a new day
There wi11 always be the dawning of another day - Iif e affords us
many different opportunities, and it is up to us to grab hold of them!
12
Appendix 1: Commonly Used Substances and Their Effects
It is helpful to understand what people commonly experience when they use alcohol and drugs. The following table lists both the positive and negative effects of alcohol and drugs.
Substance Type | Examples | Positive Effects | Negative Effects |
Alcohol | Beer, wine, gin, whiskey. vodka, tequila | Relaxation; Lighter mood | Slower reaction time; drowsiness; socially embarrassing behaviors. |
Cannabis | Marijuana, hash, 'FEC : | Relaxation; "High" feeling | Reduced reaction time and coordination; Apathy and fatigue Paranoia; Increased anxiety or panic feelings |
Stimulants | Cocaine (powder/or crack), amphetamines (crystal meth., Dexedrine) | Alert feeling; Increased euphoric or good feeling | Increased anxiety; Paranoia and; psychosis; Sleeplessness |
Hallucinogens | LSD, ecstasy, peyote, mescaline | Increased sensory experiences, Feeling of wellbeing | Bad "trips" Psychotic pilikia |
Opiates | Heroin, morphine, vicodin, Demerol, opium | Positive feeling of welI-being; Relaxation; Reduced pain sensitivity | Drowsiness; Highly addictive; Risk of overdose |
Inhalants | Glue, aerosols, paint | "High" feeling | Severe disorientation; Toxic/brain damage |
Caffeine | Coffee, some teas, some sodas | Alert feeling | Feeling jittery; Can interfere with sleep |
Nicotine | Smoking, chewing tobacco | Feeling alert Feels qood | Causes many health problems |
Benzodiazepines (Anti-anxiety medication) | Valium, Xanax, Kionopine | Reduced anxiety; Relaxation; | Rebound anxiety when medication wears off; Loss of inhibition and coordination; Dulled senses |
PAU
13
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An Effective Method for Solving Pilil<ia and Achieving Goals
When trying to solve a problem or achieve a goal, it is important to take an active, solution-focused approach. You may use a step-by-step method for solving problems and achieving goals by yourself or with your 'ohana members, friends, peers, your case manager or other health care workers. These people can be especially helpful in providing ideas for solutions of the problems you face and in carrying out specific steps of the solution you choose.
Are you experiencing a problem that is causing stress? Or is there a goal that you would like to achieve but is difficult to pursue?
You can use the following worksheet to develop a plan for solving the problem or achieving the goal.
A Step-By-Step Method:
Step 1 : Define The Problem Or Goal As Specifically And Simply As Possible
Step 2: List 3 Possible Ways To Solve The Problem Or Achieve The Goal
_
_
C..
Step 3: For Each Possibility, List One Advantage And One Disadvantage
Advantages/Pros:
Disadvantages/Cons:
_
2
Depression
When people are depressed, they may have one or more of the following problems: feeling bad about themselves, not doing the things they used to enjoy, sleeping too much or too little, low energy, poor appetite, and having trouble concentrating and making decisions.
If you are not having severe symptoms of depression, you can try the following coping methods to help improve your mood:
Ways to Cope with Depression | I Have Used It | I Would like To Try It |
1: Set goals for daily activities, starting with one or two activities and gradually building up to a full schedule. | I | I |
2: Talk with someone in your support network to let him or her know about your feelings. Sometimes they have good ideas you can try. | I | I |
3: Identify things that you still enjoy and build your strengths in those areas. | ||
4: Schedule something pleasant to do each day, even if it's a small thing. This will give you something to look forward to. | ||
5: Ask people to join you in activities. You may be more likely to follow through with plans when someone else is involved. | ||
6: Deal with loss of appetite by eating small portions of food that you like and taking your time. | ||
7: Practice relaxation exercises on a regular basis. | ||
8: Remind yourself of the steps you have accomplished and avoid focusing on setbacks. | ||
19: Other |
**If you get severely depressed or if you start thinking of hurting yourself or ending your life, you should contact your case manager immediately or seek emergency services.
7
Anger
Some people find that they feel angry or touchy much of the time and get irate about situations that would ordinarily seem relatively minor.
Because this is a common problem, there are programs for anger management, which many people have found helpful. Some of the techniques taught in anger management classes may help you control your anger:
I Ways to Cope with Anger | I tHave Used | I Would like To Try It |
1: Recognize the early signs that you are starting to feel angry (for example, heart pounding, jaw clenching, perspiring), so that you can keep things from getting out of control. | ||
2: Identify situations that commonly make you feel angry and learn how to handle these situations more effectively. | ||
3: Develop specific ways for staying calm when you're angry: C. temporarily leaving the situation, or politely changing the subject. | ||
4: Learn how to express angry feelings briefly and constructively. The following steps are helpful: C. Suggest how the situation could be avoided in the future. | ||
5. Other | ||
6. Other |
counting to ten before responding
distracting yourself,
Speak firmly but calmly.
Tell the person what he or she did to upset you. Be brief.
8
Ways to Improve Sleep:
Sleeping too much or too little can be very disruptive. It's hard to do things when you don't get enough sleep. Trying some of the following suggestions may help:
I Ways to Improve Sleep | 1 :ave Used | I Would like To Try It |
1: Go to sleep and get up at the same time everyday | I | |
12: Avoid caffeine after 6 PM II I | ||
3: Exercise during the day so you'll feel tired at night I | ||
4: Do something relaxing before going to bed, such as reading, taking a warm shower, drinking warm milk or herbal tea, or listening to music | ||
5: Make sure that your room is dark and that the temperature is comfortable | ||
6: Avoid watching violent or distressing programs on television or video just before going to bed | ||
7: Avoid having discussions about upsetting topics just before going to bed. | ||
8: Avoid napping during the day. | ||
9: Avoid spending more than 30 minutes lying awake in bed. Instead, try getting up, going to another room, and doing something relaxing (like reading or listening to music) for at least 15 minutes before returning to bed. | ||
10: Other | ||
11: Other |
9
Ito feel enjo-rment | in it. | II | II | I | |
6: Be willing to try something several times in order to get familiar with it. The more familiar and comfortable you feel with an activity, the more likely you will enjoy it. | |||||
7: Other | II | I | |||
8: Other | I | ||||
9: Other |
1
1
Ways to Increase Contact with Others
Everyone needs time alone. But if you find that you are withdrawing from people and avoiding contact with others, it may create problems in your relationships.
Ways to Increase Contact with Others | I Have Used It | I Would like To Try It |
11: Join A Support Group I | ||
2: Explore Jobs Or Volunteer Work That Involves Contact With Other People I | II I | |
3: Schedule Contact And Talk Stories With Someone Every Day, Even If It's For A Short Time | I | I |
4: If You Find It Stressful To Be With People, Practice Relaxation Techniques Before And/Or After Your Contact With Them | ||
5: Arrange For Errands That Involve Contact With People, Such As Going To The Store Or The Library | I | I |
6: If It's Too Stressful To Have Personal Contact, Call People On The Phone And Talk For At Least A Few Minutes | ||
17: Other I | I | I |
11
Strategy 3
Use the help of other people to prevent early warning signs from becoming full blown crises.
People are not always aware when their behavior has changed and they are experiencing an early warning sign of crisis. For example, someone might not realize that he or she is feeling unusually irritable. Instead, it may seem to him or her that other people are being especially annoying.
Friends, family members, co-workers, case managers or other health care workers, and other supportive people often notice when someone seems different or is acting out of character. They can help people recognize early warning signs.
If you ask them, your Ohana/family members, friends and case managers or other health care workers can be your "extra eyes and ears" for noticing early warning signs. You can tell them some possible early warning signs to look for, and let them know that you would like them to inform you when they notice these signs.
People Who Could Help Me See Early Warning Signs
Friends: -----------------------------
'Ohana Members: --------------------------
Support Group Members: _
Clubhouse Members: ------------------------
Case Manager Or Other Healthcare Worker: _
Co-Workers: ---------------------------
Others: -----------------------------
6
What can be done when you become aware that you are experiencing an early warning sign of crisis?
The more quickly you act on early warning signs, the more likely it is that you can avoid a full crisis. The following is a list of examples of what other people have experienced and what they did when they saw early warning signs. Some examples may sound familiar to you.
"When I started to feel so irritable with everyone, even my best friend, I realized that I was under a lot of stress with changes in my life. I talked with my case manager about strategies for coping with the stress better so it didn't affect me so much."
"I thought my medicine wasn't helping me, so I stopped talking it. My thinking got very confused. I kept forgetting things, too. I told the doctor at my next appointment."
"My brother noticed empty beer bottles in the kitchen when he came to visit. When we got to talking, I realized that I was starting to use alcohol to help me fall asleep. The next day I called my case manager."
"When I notice I am sleeping too much, isolating myself, or feeling bored; I know I need to call my doctor."
"I was not taking care of myself (no bath, no food, messy house, kids running around in the street), and all I wanted to do was sleep. Then I knew it was time to get help."
When early warning signs are noted, it helps to ask yourself the following questions:
Is my stress level high? What can I do to reduce it?
Am I taking part in the treatments I chose?
Am I going to my support group, doing my relaxation exercises, going to see my case manager, going to church or temple, etc.?
If medication is part of my treatment, am I taking my medication as I'm supposed to? If not, how can I make sure I do?
Should I arrange a special appointment to talk to the doctor?
Do I need to start a medication? Do I need a higher dose of the medication I am taking?
Should I contact someone for extra support (like a spiritual leader, Ohana member, etc.)?
7
Question: Have you had an experience where you were able to avoid early warning signs that you checked off on page 4 and 5? If so, what did you do?
Strategy 4
Develop Your Own Crisis Prevention Plan
It's notpossible to know who will have only one or two crises and who will have more. Making a Crisis Prevention Plan can help you avoid crises and minimize the severity of episodes that do occur.
In developing a Crisis Prevention Plan, you may find it helpful to consult with the supportive people in your life. Friends, peers, case managers and mental health care workers, ohana, and others can help you remember details about what helped in past situations and can make suggestions about possible steps to take if early warning signs appear.
Plans for preventing crises are most effective if they contain the following:
Reminders Of Past Triggers
Reminders Of Past Early Warning Signs
What Helped You In The Past When You Were Having An Early Warning Sign
Who You Would Like To Assist You
Who You Would Like Contacted In An Emergency
For example, before developing your crisis prevention plan with staff, you may want to talk with the supportive people in your life (Ohana members, friends, your counselor or case manager, and your doctor). You may ask them what they observed before your last crisis and included some of their observations in your list of early warning signs. You may also ask for their suggestions in making a plan for responding to an early warning sign and ask them whether they would be willing to play a specific part in carrying out the plan.
Questions: What would you include in your Crisis Prevention Plan? You can use the following planning sheet to record your answer.
8
Public Assistance
Each state offers different financial benefits and has different eligibility requirements. State benefit programs are often called "public assistance" or "temporary assistance for needy families" or "welfare programs." If you have a low income and have mental health problems that interfere with working full-time, you may be eligible for public assistance. It is usually a modest amount of money.
Many states also have programs to assist with the purchase of food, such as food stamps. Many states and communities have programs to help with housing costs. The housing programs may be operated by local housing authorities or by the states.
Because public assistance is funded by the state, you would apply at the state Office of Public Assistance or Office of Public Welfare. You may also be eligible for Medicaid health insurance, which is sometimes called "medical assistance."
j Depending On Your Work History And Financial Need, You May Be Eligible For SSI, SSDI Or Public Assistance.
Questions: Are you currently receiving financial benefits?
If not, do you think you might be eligible for SSDI, SSI or Public Assistance?
Health Insurance Benefits
Are You Entitled To Health Insurance Benefits?
Social workers and case managers are usually well informed about health insurance benefits. The details about these benefits may vary from year to year, so it's a good idea to start by talking to someone who knows the most recent information.
You may be eligible for one of the following health care benefits:
Medicare
If you are unable to work full-time because of mental illness and have been eligible to receive SSDI for more than two years, you may be eligible for Medicare. It usually covers inpatient and outpatient bills, although it is subject to deductibles, co-payments and "ceilings" for certain services. Medicare has two programs, Medicare A and Medicare
B. You can get information about these programs from your local Social Security Office. Even if you are not sure that you will receive Medicare or Social Security, you have the right to apply. Applications are made at the Social Security Administration Office.
7
Medicaid
If you have a low income (or no income) and have mental health problems that interfere with working full-time, you may be eligible for Medicaid, which is called "Medical Assistance" in some states. Even though the programs vary from state to state, they usually cover inpatient and outpatient bills, and medication costs. In some states you are required to pay small co-payments and there are restrictions on reimbursements. You can apply at the State Office of Public Assistance or Office of Public Welfare.
Appealing Decisions
The Social Security Administration and local state programs (such as Medicaid) have ways that you can appeal decisions that have been made about whether you are eligible for services. When you apply, ask about what the appeal process is. If you feel a decision was not made correctly, you have a right to follow the appeal process.
**Depending On Your Work History And Financial Need, You May Be Eligible For Health Insurance Benefits From Medicare Or Medicaid. **
Questions: Do you currently receive health insurance benefits?
If not, do you think you might be eligible for Medicare or Medicaid?
Speak Up for Yourself
How Can You Advocate For Yourself In The Mental Health System?
You may encounter a problem with the mental health system and may need to advocate for yourself. Here are some examples of problems that other people reported:
"I was on an endless list to see an individual counselor."
"I wanted to get a job. I couldn't find out how to get help with this."
"I was ready to leave the day treatment program, but people kept telling me there was no alternative."
Points To Remember When You Advocate For Yourself:
Keep a record of the details of the problem and what you have tried to do about it
"I kept a copy of all my applications to the apartment program. Also, when I called someone at the housing office, I wrote down the date, who I spoke to, and what we
8
Questions about What I Receive From the Mental Health
System
Questions | Answers (Please Be Specific) |
Are there additional services that I would like to receive? (see the "mental health services checklist," earlier in this handout) | |
Are there any financial benefits that I would like I to apply for? _ | |
Are there any health insurance benefits I would like to apply for? | |
Are there any food or nutrition programs that I would like to apply for? | |
Are there any housing programs or benefits that I would like to apply for? | |
Would I like to strengthen my skills at advocating I for myself? _ | |
Would I like to meet the consumer advocate at my mental health center or get to know him or her better? | |
Would I like to identify someone on my treatment team who could help me advocate for myself? | |
Is there anything else I would like to improve aboutI what I receive from the mental health system? |
PAU
11
DIE&OLA
Today, what we find is a jumbled flow of at least two distinct deep cultures within the Hawai'i society. One is prominent in the formal and the other in the informal systems of community life. The first contains strong elements of:
Domination - especially reflected in the formal economic, education, political, military and judicial systems. Ingrained within this element is the idea of expansion, an ever enlarging territory, market, or field of conquest as being a natural order of things.
Individualism - protected in the legal system, elevated in the expression of history and dominant Western philosophies. Ingrained within this element is the idea of singularity, a continual parceling apart, fragmenting of things, concepts, persons from people.
Exclusion - often accomplished by the depersonalization of the "other," the stranger. One favorite technique is by referring to others as non-human entities, "gooks" and "commies" for example instead of men, women and children, the "evil empire" instead of the people of another nation.
The acronym DIE is an easy reminder of the elements of that deep culture stream. It is prevalent in the formal economic, education, judicial and political systems of the Hawai' i society today.
The second stream contains elements of:
'Olu'olu - compatible, agreeable, creating relationships of comfort, of inter-relating with a high degree of respect and trust, even alongside one's competitor, of finding contentment with what one has, of staying within one's kuleana, territory or property;
Lokahi - collective effort, many working together for a common goal which gives a foundation for looking at the wide implications of small things,
Aloha - a propensity toward inclusion of other people and different philosophies, a searching out for the humanity within others and trying to urge that humanity to the surface of inter-relationships.
This "OLA." is generally attributed to the underlying Hawaiian culture and the multiplicity of added cultures to Hawai'i. It is entrenched in the informal economy of sharing and caring, of non-formal education, of traditional healing, of alternate dispute resolution systems and community organizing. In the Hawaiian (and other Polynesian) language, it means both health and life.
Of course, one would have to look long and hard to find a pure DIE or OLA in the general community. These deep cultures continually mix, clash, and cooperate within individuals, families, situations, and systems. They add to the schizophrenia and to the compatibility of the society which makes Hawai' i so incomprehensible for some and so delightful to others. These deep cultures are more than interesting anthropological points of inquiry. They have very serious implications to our society. They form the foundation upon which we build our relationships with one another, how we interact with our environment, our attitudes to time, justice, sharing and caring, family, medicine, . . . They are guiding forces to our individual and collective futures.
Excerpt from: On Deep Cultures in Hawai'i, Feb. 14, 2000, Poka Laenui, Institute for the Advancement of Hawaiian Affairs, http:\\www.opihi.com\soverehmty
What is stigma?
When referring to mental illness, the word "stigma" means the negative opinions and attitudes that some people have about mental illness.
Not everyone with mental illness has experienced stigma, although unfortunately, many have.
There are two major laws that protect against discrimination against people with physical or psychiatric disabilities.
The Americans with Disabilities Act (ADA) makes it illegal to discriminate in the areas of employment, transportation, communication or recreation.
The Fair Housing Act (FHA) prohibits housing discrimination.
Stigma is a complicated problem, and there are no easy solutions. Research has shown that as the general public gets to know more about mental disorders and as they get to know people who have experienced psychiatric pilikia, their negative beliefs go down.
Many organizations are working on national campaigns to educate the public and create more laws that protect against discrimination, including:
The National Institute of Mental Health, (www.nimh.nih.gov) The Center for Mental Health Services, 1-800-540-0320
The National Alliance for the Mentally Ill,(www.nami.org), 1-800-950- NAMI
The National Mental Health Association, (www.nmha.org) The National Empowerment Center, (www.power2u.org)
Strategies and Resources for Responding to Stigma What are Some Strategies for Responding to Stigma?
It may be helpful for you to develop some personal strategies for responding to stigma. There are advantages and disadvantages to each strategy. What you decide to do depends on the specific situation.
Some possible strategies include:
Educate Yourself About Mental Disorders
1
Sometimes people who experience psychiatric pilikia do not know the facts themselves. They may blame themselves for their pilikia or think they cannot take care of themselves or that they can't be part of the community. You may have had these negative thoughts or feelings. This is called "self-stigma."
It is important to fight self-stigma, because it can make you feel discouraged and cause you to lose hope in your recovery. One way to fight self-stigma is to educate yourself about psychiatric pilikia and mental disorders, and to be able to separate myths from facts. For example, knowing that no one causes schizophrenia can help you to stop blaming yourself or others.
Another way to fight self-stigma is to belong to a support group or another group where you get to know different people who have experienced psychiatric pilikia. You can locate support groups through organizations such as the Consumer Organization and Networking Technical Assistance Center (CONTAC, 1-800-598- 8847 or www.contact.org).
The more you know about mental disorders, the more you can combat prejudice, whether it comes from others or from within yourself. |
Point Out Inaccurate Information That Others Have About Mental Illness Without Disclosing Anything About Your Own Experience
A co-worker might say, "People with mental illness are all dangerous." You might decide to reply, "Actually, I read a long article in the paper that said that the majority of people with mental illness are not violent. The media just sensationalizes certain cases."
To fight stigma, you might decide to correct misinformation without disclosing personal experience |
Selectively Reveal Your Experience With Psychiatric Pilikia
Disclosing information about your own experience with psychiatric pilikia is a personal decision. It's important to think about how the other person might respond. It's also important to weigh the risks and benefits to yourself, both in
2
National Stigma Clearinghouse
245 Eighth Avenue
Suite 213
New York, NY 10011 Phone: 212-255-4411
website: community2.webtv.net/stigmanet /HOMEPAGE
Resource Center to Address Discrimination and Stigma
1-800-540-0320
website: www.adscenter.org
Federal Agencies
Equal Employment Opportunity Commission (EEOC)
1801 L Street, NW Washington, D.C. 20507
Phone: 202-663-4900
To locate the nearest office: 1-800-669-4000 website: eeoc.gov
Office of Fair Housing and Equal Opportunity (FHEO)
Department of Housing and Urban Development 451 7th Street SW
Washington, D.C. 20410
Phone: 202-708-1112
website: hud.gov
5
method of self-praise. Yet we must unashamed of our principles and honest in our criticisms.
We shall try to avoid conflict and cooperate with those who do not understand us and whom we do not understand; yet, we shall speak our truth openly and stand firm in our own beliefs and right to assert our Hawaiian identity.
We shall be patient, enduring the pains of injustice but never surrendering to or joining such injustice.
We shall respect and engage in humor, the helper to love and affection, the positive expression of humanity.
10.
(To be filled in by you)
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Additional Community Resources
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DIVERSITY IN CONSULTATION 225
events that define social reality and influence psychological experience and its behavioral manifestations. The macrosystem represents an overarching context that includes historical events such as colonization, decolonization, community, and cultural trauma (Salzman, 2001). A.n analysis of the rela ti.on between the macrosystems (i.e., history1 culture) and microsystems (i.e., family, school) is an essential component of the consultation process. Context has received increased attention by counselors and clinicians in support of efforts to promote multiculrural competency in the counseling profession. Pope-Davis, Liu, Toporek, and Britta:h.-Powell (2001) noted that "One of the significant hallmarks of multiculturai counseling is the recogni tion that context (sociopolitical,hlstorical,and cultural) is an influential fac tor that affects clients' behaviors, attitudes, experiences, world-views, and perceptions" (p. 31). fodeed it is context that frames the manner in which phenomena such as anger may be understood and thereby productively addressed clinically and through consultation services to individ uals1 com munities, and organizations. This is particularly true when clinicians and consultants work cross-culturally.
Psychological consultants address a wide range of behavioral manifes
tations in culturally diverse school settings. Sheridan (2000) described the challenges inherent in applying Conjoint Behavioral Consultation (CBC) across cultures. She noted that the manner in which "problems" are identi fied in multicultural CBC must be considered carefully in view of ecologi cal factors and contextual factors influencing the participants and therefore the process and outcomes of CBC.
Social psychology has informed us of the human tendency to attribute cause to the actor while minimizing the contribution of contextual factors. This has been called the fundamental attribution error (Krull, Loy, Lin, Wang, Chen, & Zhao, 1999; Ross, 1977), Suchatendencyrequir.es an.inten tional attention to contextual factors to assist the accurate. assessment of behavioral manifestations and to inform a congruent and effective inter vention selection. The absence of such intention and attention implies that consultants risk what Shinn and Toohey (2003) identified as context minimization error. This source of error may occur when the impact of con texts on human behavior is ignored. Shinn and Toohey reviewed evidence of associations beti.veen neighborhood and community contexts and trends in health, psychological distress1 risky behaviors, psychological at titudes, and child development. They found evidence that supported these associations. In addition to community contexts, human-behavior is also embedded in historical and cultural contexts. The probability of error in all phases of the consultation process may be reduced by due consideration.of the meaning and potential functions of symptoms (i.e., anger) in the con-
RULES (6-10) For En1otional Health In Decreasing the Potential for Relapsing
6. Supportive/Positive Relationship
9 Willingness
9 Acceptance
AKUA/GOD
(Spirituality)
F alse
E vidence
A ppean.ng
R eal
Relationship that you can be honest about your thoughts and feelings
Talk positively to yourself
8 Remove yourself from harmful situations
Accept that life is about choices and will always bring changes that will require adjusting
Have a plan for the future (HOPE)
KANAKA/SELF/SOCIETY
7. Positive Talk (Affirmations)
9. Make Positive/Good Choices
9. Make Adjustment to the Change
ENVIRONIVIENT
Remove myself from drug using situations
Change my environment to a clean, safe and drug free place
Q Paranoia
Q Auditory
O Hallucinations
Shirley J. Davenport, MSW, CSAAS, (2007): Integrating MISA (Double Trouble) with Wai'anae Wellness Model. Adapted from The Wai'anae Community Mental Health Center, Cultural adaptation of Illness Management & Self Directed Recovery, "Kumu Ola Pono (Voyage to Recovery}". © Shirley Davenport-April 12, 2007
Avoiding Stressor that Lead to Relapse The Stress Vulnerability Model Mental Illness and Substance Abuse
Higher Power/ Akua (God) Spirituality
.,c
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Drugs/Alcohol
Medications
Values
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I
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-
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Biological Vulnerability
Doctor I
Medications
Faith that Medication works
r§3
,,,/
I
I
I
PONO
Psychiatric Pilikea
•---------------------------------►
Kanaka/Society
Conditions (Aina)
COPING
(Me)
Environment/Nature
Schizophrenia
Poor Self-Image
Poor Relationships
Loss/Gain of Weight
Lack of Interest in things you once enjoy
Hallucinations
Depressive Mood
Delusions
Loss of Housing/Job & Children
Drug / Alcohol Abuse
(VERY HARD)
Bipolar
e Depression
Dependency
Addictions
Shirley J. Davenport, MSW, CSAAS, (2007): Integrating MISA (Double Trouble) with Wai'anae Wellness Model. Adapted from The Wai'anae Community Mental Health Center, Cultural adaptation of Illness Management & Self Directed Recovery, "Kumu Ola Pono (Voyage to Recovery)".© Shirley Davenport-April 19, 2007
Recognizing The Effects that Criticism Have on Individual The Stress Vulnerability Model
Mental Illness and Substance Abuse
Making Any Kind in
Failure / Opportunity
the Community
Resentments Intimidation
Criticism Complaints
Conflicts Psychiatric Pilikea
•-------------------------------
Kanaka/Society / (Me) Phy_sical Environment or Nature
(EMOTIOI\JAL CLASH) (EMOTIONAL NATURE)
Stop Taking Medications
Hurt
-Anger
Feel Less Than
Lack Confident in Self
No Concern for relationships
Ugliness'
Fights & Shouting
Loss of Housing/Job & Children
Drug / Alcohol Abuse
-Police / Legal Issues
Shirley J. Davenport, LSW, CSAAS, (2007): Integrating MISA (Double Trouble) with Wai'anae Wellness Model. Adapted from The Wai'anae Community Mental Health Center, Cultural adaptation of Illness Management & Self Directed Recovery, "Kumu Ola Pono (Voyage to Recovery)". © Shirley Davenport - April 26, 2007 (1 of 2)
Develop Strategies for Managing Criticism The Stress Vulnerability Model
(Mental Illness and Substance Abuse)
Higher Power I Akua (God) Spirituality Managing Conflict
A
I
I I I I I I
Criticism Complaints
Maintain Pono
Balance
•----------------------------►
Kanaka/Society / (Me) Physical Environment or Nature
NO
PSYCHIATRIC PILIKEA
(EMOTIONAL CLASH)
Be a manager of Conflict, Criticism and Complaints
-Not a Victim or a Bully
Talk Things Out
Look for opportunity to learn or teach, to reflect
(EMOTIONAL NATURE)
A Victim = Powerless, Blames others, want to change other prefer resentments rather than confronting the issues.
A Bully = Feel threaten, need to be right intimidated rather than confronting the issues.
Take Medications Effectively
Shirley J. Davenport, LSW, CSAAS, (2007): Integrating MISA (Double Trouble) with Wai'anae Wellness Model. Adapted from The Wai'anae Community Mental Health Center, Cultural adaptation of Illness Management & Self Directed Recovery, "Kumu Ola Pono (Voyage to Recovery)". © Shirley Davenport - April 26, 2007 (2 of 2)